A conceptual framework for the neurobiological study of resilience

The Network Structure of Adolescent Well-Being Traits: Results From a Large-Scale Chinese Sample

Background: The mental health and well-being of adolescents are becoming increasingly important globally. Understanding the relationship between different aspects of well-being is crucial for effective interventions of the well-being of adolescents. The present study aims to analyze the network structure of adolescent well-being and identify the central well-being traits.

Methods: We used a network model to analyze the network structure of a psychometrically sound measurement of adolescent well-being – the engagement, perseverance, optimism, connectedness, and happiness (EPOCH) scale. The dataset comes from a representative sample of Chinese adolescents (17, 854 participants from rural and urban areas from Southern, Northern, and the middle part of China).

Results: The 20 items of EPOCH formed a highly interconnected network. The item H4 (“I am a cheerful person.”), item E2 (“I get completely absorbed in what I am doing”), and item O4 (“I believe that things will work out, no matter how diffcult they seem”) were the traits with the highest centrality in the network.

Conclusions: Cheerfulness, engagement in current activity, and optimism for the future are most central to the psychological well-being of Chinese adolescents. Future studies should further test the dynamics between these central traits and other well-being traits to find effective interventions of well-being of adolescents.

Neurocognitive Mechanism of Human Resilience: A Conceptual Framework and Empirical Review

Resilience is an innate human capacity that holds the key to uncovering why some people rebound after trauma and others never recover. Various theories have debated the mechanisms underlying resilience at the psychological level but have not yet incorporated neurocognitive concepts/findings. In this paper, we put forward the idea that cognitive flexibility moderates how well people adapt to adverse experiences, by shifting attention resources between cognition–emotion regulation and pain perception. We begin with a consensus on definitions and highlight the role of cognitive appraisals in mediating this process. Shared concepts among appraisal theories suggest that cognition–emotion, as well as pain perception, are cognitive mechanisms that underlie how people respond to adversity. Frontal brain circuitry sub-serves control of cognition and emotion, connecting the experience of physical pain. This suggests a substantial overlap between these phenomena. Empirical studies from brain imaging support this notion. We end with a discussion of how the role of the frontal brain network in regulating human resilience, including how the frontal brain network interacts with cognition–emotion–pain perception, can account for cognitive theories and why cognitive flexibilities’ role in these processes can create practical applications, analogous to the resilience process, for the recovery of neural plasticity.

Modelling resilience in adolescence and adversity: a novel framework to inform research and practice

Recent conceptualisations of resilience have advanced the notion that it is a dynamic and multifaceted construct. However, its adaptive components, especially those forged by adversity, have not been fully realised, and its neurobiological and psychosocial underpinnings are yet to be meaningfully integrated. In part, this is because a developmental perspective is often neglected in the formulation of resilience. In this review, we consider the findings of resilience research, with a specific emphasis on the developmental period of adolescence. To bridge the gaps in our current understanding, we propose a model of resilience that is predicated on experiencing adversity. Specifically, our model provides a sophisticated insight into the components of resilience, which, together with intrinsic features, involves facilitation of, and skill acquisition via strengthening processes we term tempering and fortification. The model also points to the potential trajectories of adversity-driven resilience and forms the basis of a framework that allows for individual variance in resilience, and the identification of both neurobiological and psychosocial targets for prevention and therapeutic interventions.

Towards a Transversal Definition of Psychological Resilience: A Literature Review

Background and objectives: This paper addresses psychological resilience, a multidisciplinary theoretical construct with important practical implications for health sciences. Although many definitions have been proposed in several contexts, an essential understanding of the concept is still lacking up to now. This negatively affects comparisons among research results and makes objective measurement difficult. The aim of this review is to identify shared elements in defining the construct of resilience across the literature examined in order to move toward a conceptual unification of the term. Materials and methods: A literature review was performed using the electronic databases 'PubMed' and 'PsycINFO'. Scientific studies written in English between 2002 and May 2019 were included according to the following key terms: 'Psychological', 'resilience', and 'definition'. Results: The review identifies five macro-categories that summarize what has been reported in the recent literature concerning the resilience phenomenon. They serve as a preliminary and necessary step toward a conceptual clarification of the construct. Conclusions: We propose a definition of psychological resilience as the ability to maintain the persistence of one's orientation towards existential purposes. It constitutes a transversal attitude that can be understood as the ability to overcome the difficulties experienced in the different areas of one's life with perseverance, as well as good awareness of oneself and one's own internal coherence by activating a personal growth project. The conceptual clarification proposed will contribute to improving the accuracy of research on this topic by suggesting future paths of investigation aimed at deeply exploring the issues surrounding the promotion of resilience resources.

The Impact of Acute Stress Physiology on Skilled Motor Performance: Implications for Policing

Investigations of police performance during acutely stressful situations have primarily focused on higher-order cognitive processes like attention, affect or emotion and decision-making, and the behavioral outcomes of these processes, such as errors in lethal force. However, behavioral outcomes in policing must be understood as a combination of both higher-order processes and the physical execution of motor skills. What is missing from extant police literature is an understanding of how physiological responses to acute stress contribute to observed decrements in skilled motor performance at the neuromuscular level. The purpose of the current paper is to fill this knowledge gap in the following ways: (1) review scientific evidence for the physiological (i.e., autonomic, endocrine, and musculoskeletal) responses to acutely stressful exposures and their influence on skilled motor performance in both human and animal models, (2) review applied evidence on occupationally relevant stress physiology and observed motor decrements in performance among police, and (3) discuss the implications of stress physiology for police training and identify future directions for applied researchers. Evidence is compelling that skill decay is inevitable under high levels of acute stress; however, robust evidence-informed training practices can help mitigate this decay and contribute to officer safety.

How does carer resilience change over time and care status? A qualitative longitudinal study

Objectives: Little research examines trajectories of carer resilience or the factors that facilitate or hinder resilience over time. We use qualitative longitudinal methods to examine trajectories of resilience and which assets and resources are associated with resilience and care status transitions in spousal dementia carers. Method: Based on an original sample of 23 spousal dementia carers (Donnellan, Bennett, & Soulsby, 2015 ), we conducted 13 follow-up interviews, including: 5 continuing home carers, 3 former carers (institutionalised), and 5 former carers (widowed). Results: Five participants remained resilient (stable resilient), three remained non-resilient (stable non-resilient) and four participants became resilient (non-resilient to resilient). Only one participant became non-resilient (resilient to non-resilient). Stable resilience was characterised by continuing individual assets and community resources. Carers who became resilient returned to previous resources, or gained new resources. Conclusion: Institutionalisation and widowhood are not always barriers to resilience; spousal dementia carers can remain or even become resilient over time despite deteriorating health, institutionalisation, or death of the care recipient.

Designing resilience research: Using multiple methods to investigate risk exposure, promotive and protective processes, and contextually relevant outcomes for children and youth

BACKGROUND

Inconsistent, poorly designed research on resilience in the human sciences has contributed to epistemological and ontological ambiguity which has fuelled claims that resilience as a concept is poorly theorized.

OBJECTIVE

Building on research with abused and neglected children around the world, the objective of this paper is to show that studies of resilience must account for: (a) risk exposure (of relevance in different contexts); (b) promotive and protective processes (internal and external resources associated with resilience across systems); and (c) desired outcomes (as privileged by stakeholders in different cultures and contexts).

METHOD

By identifying common aspects of resilience research from a purposeful selection of studies (ones with weak and strong methodologies), this paper identifies three dimensions of well-designed studies of childhood resilience.

RESULTS

Attention to all three dimensions enhances both the empirical validity (in the quantitative research paradigm) and phenomenological trustworthiness (in qualitative research) of resilience research with children and families. Challenges researching resilience can also be resolved by designing studies that account for all three dimensions. These challenges include the lack of systemic thinking to account for contextual factors and other external threats to child wellbeing, and the excessive generalization of findings.

CONCLUSION

This three-part model for resilience research reflects the very best practices among resilience researchers and has the potential to address the definitional and methodological ambiguity that plague studies of resilience.

Validierung einer deutschen Version der Resilience Scale for Adults (RSA)

Zusammenfassung. Bislang war im deutschen Sprachraum kein Fragebogen vorhanden, der den multifaktoriellen Konstrukteigenschaften der Resilienz gerecht wird. Ziel der vorliegenden Untersuchung war es daher, eine deutsche Version eines multifaktoriellen, personelle, familiäre und soziale Schutzfaktoren abbildenden Selbstauskunftsfragebogens, der Resilience Scale for Adults (RSA) zu validieren. Hierzu wurde eine internetbasierte Querschnittsuntersuchung an einer nicht-klinischen Stichprobe ( N = 524) durchgeführt. Ergänzend wurde explorativ eine klinische Stichprobe von Patientinnen und Patienten mit einer ersten depressiven Episode ( N = 69) mit der RSA untersucht. Eine konfirmatorische Faktorenanalyse bestätigte eine akzeptable Passung des postulierten Sechs-Faktoren-Modells. Die internen Konsistenzen der Subskalen und der Gesamtskala RSA waren moderat bis hoch einzuschätzen, eine Ausnahme bildete hierbei die Subskala Strukturiertheit. Signifikant positive sowie negative Korrelationen mit Fragebögen zur wahrgenommenen Resilienz, sozialen Unterstützung und Beeinträchtigung durch Symptombelastungen belegten die Konstruktvalidität. Die Probanden der nicht-klinischen Stichprobe erreichten im Vergleich zur klinischen Stichprobe in allen RSA Subskalen sowie dem Gesamtskalenwert signifikant bessere Summenwerte. Mit der untersuchten Version der RSA steht dem deutschsprachigen Raum erstmals ein reliables und valides Instrument zur Verfügung, das auf ökonomische Weise eine multifaktorielle Erfassung des individuellen Schutzfaktorenrepertoires und damit der potentiellen psychischen Resilienz gegenüber widrigen Lebensumständen ermöglicht.

The Association Between Resilience and Mental Health in the Somatically Ill

BACKGROUND

Resilience refers to an individual's positive adaptation to the experience of adversity. The maintenance of mental health is commonly considered a sign of successful coping with adverse conditions. The goal of the present meta-analysis was to investigate the association between resilience and mental health in patients with a somatic illness or health problem.

METHODS

Studies were included if they reported measures of association between resilience, as assessed using a version of Wagnild and Young's Resilience Scale, and self-reported mental health. A systematic literature search was conducted in the Medline, Web of Science, PsycInfo, PubPsych, and ProQuest databases and in the dissertation catalogue of the German National Library. In addition, a manual search was carried out. The study was registered with PROSPERO (registration number: CRD42017054822).

RESULTS

55 studies involving a total of 15 003 patients were included in the meta-analysis. Assuming a random-effects model, the weighted mean Pearson correlation between resilience and mental health was r = 0.43 (95% confidence interval [0.39; 0.48], p<0.001). This association was robust, although the heterogeneity among individual effect sizes was substantial (I2 = 89.6%). Correlations tended to be weaker in unpublished studies than in published ones.

CONCLUSION

Despite substantial heterogeneity across studies, the findings suggest a strong association between resilience and mental health in the somatically ill. In clinical practice, a lack of resilience as a resource for successful coping might indicate a need for psychosocial support during treatment for somatic illness.

Factors that contribute to psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses: qualitative study

BACKGROUND

Suicide is a leading cause of premature death in people with a diagnosis of schizophrenia. Although exposure to stressors can play a part in the pathways to death by suicide, there is evidence that some people with a diagnosis of schizophrenia can be resilient to the impact of suicide triggers.

AIMS

To investigate factors that contribute to psychological resilience to suicidal thoughts and behaviours from the perspectives of people with a diagnosis of schizophrenia.

METHOD

A qualitative design was used, involving semi-structured, face-to-face interviews. Twenty individuals with non-affective psychosis or schizophrenia diagnoses who had experience of suicide thoughts and behaviours participated in the study. The interviews were audio-recorded, transcribed verbatim and examined using inductive thematic analysis.

RESULTS

Participants reported that psychological resilience to suicidal thoughts and behaviours involved ongoing effort. This ongoing effort encompassed: (a) understanding experiences (including reconciliation to mental health experiences and seeking reasons to live), (b) active behaviours (including talking to people and keeping occupied), and (c) relationship dynamics (including feeling supported by significant others and mental health professionals).

CONCLUSIONS

Psychological resilience was described as a dynamic process that developed over time through the experiences of psychosis and the concomitant suicidal experiences. Psychological resilience can be understood using a multicomponential, dynamic approach that integrates buffering, recovery and maintenance resilience models. In order to nurture psychological resilience, interventions should focus on supporting the understanding and management of psychosis symptoms and concomitant suicidal experiences.

DECLARATION OF INTEREST

None.

[Resilience trajectories-examples from longitudinal studies]

BACKGROUND

According to current research concepts resilience can be defined as adaptation to past and ongoing exposure. Accordingly, adaptation to exposure is a dynamic process, which can be different in different population groups. Prospective longitudinal studies provide unique opportunities to investigate resilience processes.

OBJECTIVES

The aim of this article is to define the concept of resilience, describe examples of longitudinal studies investigating resilience in children, adults and older individuals, exemplary describe four ongoing longitudinal resilience studies in which the authors of the article are participating and identify and analyze methodological challenges in empirical resilience research.

MATERIAL AND METHODS

This study was based on a qualitative literature review of published prospective studies investigating resilience listed in PubMed and study protocols of the four longitudinal studies.

RESULTS

The exemplarily described studies have shown that resilience processes are changeable in all age groups and subject to a variety of influencing factors. The specific and potentially age-associated types of alterations have so far been difficult to determine and need further clarification.

DISCUSSION

In view of the dynamic course of resilience, prospective longitudinal studies are urgently needed. Prospective longitudinal studies have the potential to identify resilience mechanisms and predictors of the course of resilience in different population groups, such as children, adolescents, adults and older individuals. Furthermore, resilience research needs to develop an improved and precise assessment of exposure to stressors.

[Who stays healthy? The problem of predicting resilience]

BACKGROUND

Resilience is a complex construct commonly defined as a dynamic process of maintenance or rapid restoration of mental health during and following exposure to stress and trauma. Resilient individuals show no or only minimal disruption in their overall functioning following trauma. Predictors of individual resilience are currently unclear.

OBJECTIVE

Are there significant and reliable predictors of resilience?

MATERIAL AND METHODS

Analysis and summary of recent studies on psychosocial and neurobiological resilience predictors derived from longitudinal studies.

RESULTS

Less than half of the studies on psychosocial and neurobiological predictors reviewed indexed predictors for resilience prior to exposure to the traumatic event. The results are heterogeneous and often not replicated across studies. Even significant predictors often explain only a relatively small or clinically insignificant amount of variance in resilience.

CONCLUSION

The results are not yet ready for direct implementation into practice and the development of appropriate prevention programs on the basis of significant predictors.

[Current concepts of resilience research]

BACKGROUND

Stress-related mental disorders are the most prevalent and cost-intensive disorders of our time. On the other hand, the maintenance of mental health despite stressors, i. e. resilience, is a frequent phenomenon. Research on psychological resilience and its underlying mechanisms offers innovative possibilities for health promotion. It requires a consistent understanding of resilience and adequate methods of operationalization.

OBJECTIVES

Modern concepts of the definition, operationalization and assessment of resilience as well as its implications for study designs in resilience research.

MATERIAL AND METHODS

Analysis and discussion of current works and expert recommendations for the design of resilience research.

RESULTS

Resilience research is undergoing a period of transition. Based on a new understanding of resilience as a dynamic and modifiable process, new approaches for operationalization and assessment were proposed. These include, for example, a transdiagnostic approach and the identification of resilience mechanisms, the consideration of stressor exposure in measuring the construct, and longitudinal cohort studies.

CONCLUSIONS

In the upcoming decades, further profitable findings from current prospective longitudinal studies can be expected. One challenge for future resilience research consists in the continuous dissemination and implementation of the approaches described.

Resilience as a multimodal dynamic process

AIM

Resilience is rapidly gaining momentum in mental health literature. It provides a new understanding of the highly variable trajectories of mental illness, and has consistently been linked with improved mental health outcomes. The present review aims to clarify the definition of resilience and to discuss new directions for the field.

METHODS

After discussing the definition of resilience, this narrative review synthesizes evidence that identifies the specific protective factors involved in this process. This review also addresses the mechanisms that underlie resilience.

RESULTS

Recent literature has clarified the three core components of resilience, which are the presence of an adversity or specific risk for mental illness; the influence of protective factors that supersede this risk; and finally, a subsequently more positive outcome than expected. Now that these are largely agreed upon, the field should move on to addressing other topics. Resilience is a dynamic process by which individuals utilize protective factors and resources to their benefit. It can vary within one individual across time and circumstance. It can also refer to good functional outcomes in the context of diagnosable illness. While previous research has focused on psychological resilience, it is essential that resilience is conceptualized across modalities.

CONCLUSIONS

The field should move towards the development of a multimodal model of resilience. Researchers should now focus on producing empirical research which clarifies the specific protective factors and mechanisms of the process, aligning with the core concepts of resilience. This growing, more homogeneous evidence base, can then inform new intervention strategies.

Deconstructing and Reconstructing Resilience: A Dynamic Network Approach

Resilience is still often viewed as a unitary personality construct that, as a kind of antinosological entity, protects individuals against stress-related mental problems. However, increasing evidence indicates that maintaining mental health in the face of adversity results from complex and dynamic processes of adaptation to stressors that involve the activation of several separable protective factors. Such resilience factors can reside at biological, psychological, and social levels and may include stable predispositions (such as genotype or personality traits) and malleable properties, skills, capacities, or external circumstances (such as gene-expression patterns, emotion-regulation abilities, appraisal styles, or social support). We abandon the notion of resilience as an entity here. Starting from a conceptualization of psychiatric disorders as dynamic networks of interacting symptoms that may be driven by stressors into stable maladaptive states of disease, we deconstruct the maintenance of mental health during stressor exposure into time-variant dampening influences of resilience factors onto these symptom networks. Resilience factors are separate additional network nodes that weaken symptom-symptom interconnections or symptom autoconnections, thereby preventing maladaptive system transitions. We argue that these hybrid symptom-and-resilience-factor networks provide a promising new way of unraveling the complex dynamics of mental health.

Genome-wide analyses of psychological resilience in U.S. Army soldiers

Though a growing body of preclinical and translational research is illuminating a biological basis for resilience to stress, little is known about the genetic basis of psychological resilience in humans. We conducted genome-wide association studies (GWASs) of self-assessed (by questionnaire) and outcome-based (incident mental disorders from predeployment to postdeployment) resilience among European (EUR) ancestry soldiers in the Army study to assess risk and resilience in servicemembers. Self-assessed resilience (N = 11,492) was found to have significant common-variant heritability (h² = 0.162, se = 0.050, p = 5.37 × 10^-4 ), and to be significantly negatively genetically correlated with neuroticism (r_g  = -0.388, p = .0092). GWAS results from the EUR soldiers revealed a genome-wide significant locus on an intergenic region on Chr 4 upstream from doublecortin-like kinase 2 (DCLK2) (four single nucleotide polymorphisms (SNPs) in LD; top SNP: rs4260523 [p = 5.65 × 10^-9 ] is an eQTL in frontal cortex), a member of the doublecortin family of kinases that promote survival and regeneration of injured neurons. A second gene, kelch-like family member 36 (KLHL36) was detected at gene-wise genome-wide significance [p = 1.89 × 10^-6 ]. A polygenic risk score derived from the self-assessed resilience GWAS was not significantly associated with outcome-based resilience. In very preliminary results, genome-wide significant association with outcome-based resilience was found for one locus (top SNP: rs12580015 [p = 2.37 × 10^-8 ]) on Chr 12 downstream from solute carrier family 15 member 5 (SLC15A5) in subjects (N = 581) exposed to the highest level of deployment stress. The further study of genetic determinants of resilience has the potential to illuminate the molecular bases of stress-related psychopathology and point to new avenues for therapeutic intervention.

A Copernican Approach to Brain Advancement: The Paradigm of Allostatic Orchestration

There are two main paradigms for brain-related science, with different implications for brain-focused intervention or advancement. The paradigm of homeostasis (“stability through constancy,” Walter Cannon), originating from laboratory-based experimental physiology pioneered by Claude Bernard, shows that living systems tend to maintain system functionality in the direction of constancy (or similitude). The aim of physiology is to elucidate the factors that maintain homeostasis, and therapeutics aim to correct abnormal factor functions. The homeostasis paradigm does not formally recognize influences outside its controlled experimental frames and it is variable in its modeling of neural contributions. The paradigm of allostatic orchestration (PAO) extends the principle of allostasis (“stability through change”) as originally put forth by Peter Sterling. The PAO originates from an evolutionary perspective and recognizes that biological set points change in anticipation of changing environments. The brain is the organ of central command, orchestrating cross-system operations to support optimal behavior at the level of the whole organism. Alternative views of blood pressure regulation and posttraumatic stress disorder (PTSD) illustrate differences between the paradigms. For the PAO, complexities of top-down neural effects and environmental context are foundational (not to be “factored out”), and anticipatory regulation is the principle of their interface. The allostatic state represents the integrated totality of brain-body interactions. Health itself is an allostatic state of optimal anticipatory oscillation, hypothesized to relate to the state of criticality, a mathematical point of poise between phases, on the border between order and disorder (or the “edge of chaos”). Diseases are allostatic states of impaired anticipatory oscillations, demonstrated as rigidifications of set points across the brain and body (disease comorbidity). Conciliation of the paradigms is possible, with “reactive homeostasis” resolved as an illusion stemming from the anticipation of environmental monotony. Considerations are presented with respect to implications of the two paradigms for brain-focused intervention or advancement; the hypothesis that the state of criticality is a vehicle for evolutionary processes; concordance with a philosophy of freedom based on ethical individualism as well as self-creativity, non-obsolescence, empowerment, and citizenship; and concluding reflections on the science and ethics of the placebo, and the potential for virtuous cycles of brain-Anthropocene interactions.

Understanding Resilience and Preventing and Treating PTSD

Resilience is defined as the dynamic ability to adapt successfully in the face of adversity, trauma, or significant threat. Some of the key early studies of resilience were observational studies in children. They were followed by research in adults, studies testing interventions to promote resilience in different populations, and a recent upsurge of studies on the underlying genomic and neurobiological mechanisms. Neural and molecular studies in preclinical models of resilience are also increasingly identifying active stress adaptations in resilient animals. Knowledge gained from animal and human studies of resilience can be harnessed to develop new preventive interventions to enhance resilience in at-risk populations. Further, treatment interventions focused on enhancing potentially modifiable protective factors that are consistently linked to psychological resilience can enrich currently available treatment interventions for individuals with posttraumatic stress disorder (PTSD). Translating our expanding knowledge of the neurobiology of resilience additionally promises to yield novel therapeutic strategies for treating this disabling condition. This review summarizes the vast field of resilience research spanning genomic, psychosocial, and neurobiological levels, and discusses how findings have led and can lead to new preventive and treatment interventions for PTSD.

Gender Differences in Generating Cognitive Reappraisals for Threatening Situations: Reappraisal Capacity Shields Against Depressive Symptoms in Men, but Not Women

Despite major research interest regarding gender differences in emotion regulation, it is still not clear whether men and women differ in their basic capacity to implement specific emotion regulation strategies, as opposed to indications of the habitual use of these strategies in self-reports. Similarly, little is known on how such basic capacities relate to indices of well-being in both sexes. This study took a novel approach by investigating gender differences in the capacity for generating cognitive reappraisals in adverse situations in a sample of 67 female and 59 male students, using a maximum performance test of the inventiveness in generating reappraisals. Participants' self-perceived efficacy in emotion regulation was additionally assessed. Analyses showed that men and women did not differ in their basic capacity to generate alternative appraisals for anxiety-eliciting scenarios, suggesting similar functional cognitive mechanisms in the implementation of this strategy. Yet, higher cognitive reappraisal capacity predicted fewer depressive daily-life experiences in men only. These findings suggest that in the case of cognitive reappraisal, benefits for well-being in women might depend on a more complex combination of basic ability, habits, and efficacy-beliefs, along with the use of other emotion regulation strategies. The results of this study may have useful implications for psychotherapy research and practice.

A Multilevel Investigation of Resiliency Scales for Children and Adolescents: The Relationships Between Self-Perceived Emotion Regulation, Vagally Mediated Heart Rate Variability, and Personal Factors Associated With Resilience

Personal resiliency refers to individual attributes that are related to the process of successfully adapting to the environment in the face of adverse conditions, also known as resilience. Emotion regulation is increasingly found as a core component in mental health and found to modulate individual differences in the management of emotional responses. The Resiliency Scales for Children and Adolescents (RSCA; Prince-Embury, 2006, 2007) were designed to systematically identify and quantify core personal qualities of resiliency in youth, and includes Sense of Mastery scale (MAS), Sense of Relatedness scale (REL), and Emotional Reactivity (REA) scale. The following study was first conducted to confirm the Three-Factor model of Personal Resiliency in a Norwegian student sample using factor analytic procedures. Secondly and the main purpose of the study, was to investigate if personal resiliency is associated with self-reported measures related to emotion regulation, and with resting vagally mediated heart rate variability (vmHRV) as a psychophysiological index of emotion regulation capacity. A revised scale adapted to the Norwegian sample was developed. Results indicate that protective indices related to personal resiliency are associated with both self-reported adaptive emotion regulation and outcome, and partly related to high capacity for emotion regulation indicated by vmHRV. Risk related to personal vulnerability was associated with maladaptive emotion regulation and outcome, but was not associated with emotion regulation capacity. Together the findings provide supporting evidence of both self-reported and psychophysiological correlates between emotion regulatory processes and personal resiliency indicated by RSCA.

Humorous cognitive reappraisal: More benign humour and less "dark" humour is affiliated with more adaptive cognitive reappraisal strategies

The capacity to find humorous perspectives in aversive situations may outline a helpful strategy in the context of cognitive reappraisal. Yet, research suggested that some people produce more adaptive humour than others. At the same time, not all forms of cognitive reinterpretation seem to be unequivocally beneficial. The present study aimed to investigate specific cognitive reappraisal strategies that individuals employ in humorous reappraisal of adverse events. In a sample of 95 participants, the use of cognitive reappraisal sub-strategies was assessed in a behavioural test in which participants were required to generate a series of humorous reappraisals of self-relevant, threatening events. These reappraisal sub-strategies (three positive reinterpretation strategies, three de-emphasising strategies) were then related to the habitual use of different kinds of humour as well as the broader DSM-5 personality trait domains and well-being in terms of depressive experiences, assessed by self-report questionnaires. While no robust relationships were found for reappraisal strategies based on de-emphasising, sub-strategies within the positive reinterpretation category showed specific and contrasting associations with the examined traits. Findings indicated that the ability to produce humour is only linked to a favourable pattern of reappraisal strategies when manifested in benign forms of humour. Specific relations also emerged for the broader personality traits. The study suggests that some characteristics that advance the use of benign humour also benefit adaptive emotion regulation. The opposite seems to be true for malicious, or "dark" humour. The introduced behavioural approach to the analysis of humorous cognitive reappraisal may prove useful also in future related research.

Greek Version of the Connor-Davidson Resilience Scale: Psychometric Properties in a Sample of 546 Subjects

BACKGROUND/AIM

To evaluate psychometric properties of the Connor and Davidson Resilience Scale (CD-RISC) in a Greek population.

MATERIALS AND METHODS

Internal consistency and test-retest reliability were measured. Global Assessment of Functioning Scale (GAF), World Health Organization Quality of Life (WHOQOL) questionnaire, Perceived Stress Scale (PSS) and General Health Questionnaire (GHQ) were used as measures for convergent reliability. Factors were extracted by using exploratory factor analysis (EFA). A total of 546 subjects (244 healthy individuals and 302 psychiatric patients) were recruited.

RESULTS

The scale showed excellent internal consistency (Cronbach's alpha=0.925), as well as excellent test-retest reliability (intra-class correlation coefficient=0.925). CD-RISC scores were positively correlated to GAF and WHOQOL scores, while being negatively correlated to PSS and GHQ scores, establishing adequate convergent validity. We decided on a model with four factors, in order to form sub-scales that measure different, but related aspects of resilience.

CONCLUSION

CD-RISC is a reliable and valid measure of resilience and can be used for clinical and research aims in the Greek population.

Between vulnerability and resilience: A network analysis of fluctuations in cognitive risk and protective factors following remission from depression

Research exploring how cognitive risk- and protective factors relate following remission from internalizing disorders suggests a central role for resilience. However, it remains unclear what constitutes resilience in this context. Furthermore, previous studies have typically relied on cross-sectional data which do not allow to map the temporal dynamics of such relations. Using a seven-day experience sampling period in 85 remitted depressed patients, we examined the interplay between five transdiagnostic vulnerability- and protective factors in daily life. We present a temporal, contemporaneous, and a between-subjects network, providing an in-depth analysis of how these factors relate to daily life fluctuations in residual symptomatology. Furthermore, we test the role of positive affect as a main resilience factor. Resilience uniquely predicted all other factors over time (temporal network). Higher levels of resilience were related to less momentary use of rumination, more deployment of positive appraisal, and lower occurrence of residual symptoms (contemporaneous network). Participants scoring high on resilience mostly engaged in positive appraisal (between-subjects network). Similar structures were obtained when substituting self-reported resilience by positive affect. This highlights the importance of resilience, and in particular, positive affectivity, to cope with stressors following remission. This may be fostered by facilitating the use of positive appraisal.

Resilience in Cancer Patients

Background: Being diagnosed with cancer and undergoing its treatment are associated with substantial distress that can cause long-lasting negative psychological outcomes. Resilience is an individual's ability to maintain or restore relatively stable psychological and physical functioning when confronted with stressful life events and adversities. Posttraumatic growth (PTG) can be defined as positive life changes that result from major life crises or stressful events. Objectives: The aims of this study were to 1) investigate which factors can strengthen or weaken resilience and PTG in cancer patients and survivors; 2) explore the relationship between resilience and PTG, and mental health outcomes; and 3) discuss the impact and clinical implications of resilience and PTG on the process of recovery from cancer. Methods: A literature search was conducted, restricted to PubMed from inception until May 2018, utilizing the following key words: cancer, cancer patients, cancer survivors, resilience, posttraumatic growth, coping, social support, and distress. Results: Biological, personal, and most importantly social factors contribute to cancer patients' resilience and, consequently, to favorable psychological and treatment-related outcomes. PTG is an important phenomenon in the adjustment to cancer. From the literature included in this review, a model of resilience and PTG in cancer patients and survivors was developed. Conclusions: The cancer experience is associated with positive and negative life changes. Resilience and PTG are quantifiable and can be modified through psychological and pharmacological interventions. Promoting resilience and PTG should be a critical component of cancer care.

Construct Validity and Population-Based Norms of the German Brief Resilience Scale (BRS)

Abstract. The Brief Resilience Scale (BRS) measures the ability to recover from stress. To provide further evidence for construct validity of the German BRS and to determine population-based norms, a large sample (N = 1,128) representative of the German adult population completed a survey including the BRS and instruments measuring perceived stress and the resilience factors optimism, self-efficacy, and locus of control. Confirmatory factor analyses showed best model fit for a five-factor model differentiating the ability to recover from stress from the three resilience factors. On the basis of latent and manifest correlations, convergent and discriminant validity of the BRS were fair to good. Female sex, older age, lower weekly working time, higher perceived stress, lower optimism, and self-efficacy as well as higher external locus of control predicted lower BRS scores, that is, lower ability to recover from stress.

Building Resilience: The Conceptual Basis and Research Evidence for Resilience Training Programs

The relationship between adverse experiences and later development has been explored by many researchers, leading to the conceptualization of resilience as a factor explaining the normal or optimal development of some individuals exposed to adversity. Today many different interventions exist aiming to improve the ability of individuals to respond to adversity. In this narrative literature review, we evaluate the literature surrounding resilience and resilience training, discussing the quality of the evidence supporting resilience training, theoretical and practical differences between types of training, and the impact of resilience and psychological training on outcome measures across a variety of settings. The results of our review show that the quality of the literature is mixed, resilience training is not well differentiated from other forms of training, and that the impact of psychological training on later functioning depends heavily on the type of outcome measured and the setting of the training. Further research must be conducted prior to the implementation of resilience training programs in order to assure their efficacy and effectiveness in proposed contexts.

The structure of resilience in irritable bowel syndrome and its improvement through hypnotherapy: Cross-sectional and prospective longitudinal data

BACKGROUND

Resilience refers to a class of variables that are highly relevant to wellbeing and coping with stress, trauma, and chronic adversity. Despite its significance for health, resilience suffers from poor conceptual integration. Irritable bowel syndrome (IBS) is a functional disorder with altered psychological stress reactivity and a brain-gut-microbiota axis, which causes high levels of chronic strain. Gut-directed Hypnotherapy (GHT) is a standardized treatment for IBS aimed at improving resilience. An improvement of resilience as a result of GHT has been hypothesized but requires further investigation. The aims of the study were to validate the construct and develop an integrational measure of various resilience domains by dimensional reduction, and to investigate changes in resilience in IBS patients after GHT.

METHOD

A total of N = 74 gastroenterology outpatients with IBS (Rome III criteria) were examined in 7 resilience domains, quality of life, psychological distress and symptom severity. Of these, n = 53 participated in 7 to 10 GHT group sessions (Manchester protocol). Post-treatment examinations were performed on average 10 months after last GHT session.

RESULTS

Resilience factors proved to be unidimensional in the total sample. Greater resilience (composite score of resilience domains) and quality of life, and lower symptom severity and psychological distress were found after treatment (n = 16). Similar differences were present in cross-sectional comparisons of n = 37 treated vs. n = 37 untreated patients.

CONCLUSION

Resilience factors share a common psychological dimension and are functionally connected. The absence of maladaptive behaviours contributes to resilience. Improvements in resilience after hypnotherapy with parallel increases in quality of life and reduced psychological distress and symptom severity were observed. Independent replications with larger sample sizes and randomized controlled trials are needed.

Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol

Background

This research program aims to investigate the implementation and effects of a theoretically promising prevention method. It is being developed in a European research collaboration within a Comenius project (2012–2015) between 6 European universities (in Malta, Italy, Greece, Croatia, Portugal and Sweden) with the purpose of enhancing European children’s resilience.

Methods/design

RESCUR in Sweden consists in a RCT study of the Resilience Curriculum (RESCUR) that is taking place in Sweden 2017–2019. The study is being performed by Junis, IOGT-NTO’s Junior Association, part of IOGT International, in conjunction with researchers at Göteborg, Umeå and Stockholm universities, and is being funded by the Public Health Agency of Sweden.

Around 1000 children of the ages 7–12 will, through their schools and associations, or via groups in social services, be acquainted with the material. Children will learn and practice mindfulness, storytelling, group discussions and much more, all designed to strengthen protective factors and increase their resilience. The program also involves parents, who are taking part in the work to reinforce children’s protective factors.

Based on the work with groups of children, an effectiveness study including children aged 7–12 in school classes, with randomized and controlled pre- and post-measurements, self-rating questionnaires and group observations is being performed. The program will also be implemented in a non-governmental organization and in groups in social services. The study also investigates forms of implementation.

Discussion

The design of the study will enable the researchers to answer five research questions by using a mixed-methods approach. Implementation will be studied, which is a necessary prerequisite for an effect study. Moreover, the research procedure has been tailored to the target group, with age-appropriate measures as well as multiple informants, which will produce high-quality data for analysis. A special ethical challenge is the study of young children, and efforts to give children a voice have been included in the program. This project is regarded as having good potential to benefit children in general, and particularly children in vulnerable positions.

Trial registration

National Institute of Health, ClinicalTrials.gov identifier NCT03655418. Registered August 31, 2018.

A Network Model of Resilience Factors for Adolescents with and without Exposure to Childhood Adversity

Resilience factors (RFs) help prevent mental health problems after childhood adversity (CA). RFs are known to be related, but it is currently unknown how their interrelations facilitate mental health. Here, we used network analysis to examine the interrelations between ten RFs in 14-year-old adolescents exposed ('CA'; n = 638) and not exposed to CA ('no-CA'; n = 501). We found that the degree to which RFs are assumed to enhance each other is higher in the no-CA compared to the CA group. Upon correction for general distress levels, the global RF connectivity also differed between the two groups. More specifically, in the no-CA network almost all RFs were positively interrelated and thus may enhance each other, whereas in the CA network some RFs were negatively interrelated and thus may hamper each other. Moreover, the CA group showed more direct connections between the RFs and current distress. Therefore, CA seems to influence how RFs relate to each other and to current distress, potentially leading to a dysfunctional RF system. Translational research could explore whether intervening on negative RF interrelations so that they turn positive and RFs can enhance each other, may alter 'RF-mental distress' relations, resulting in a lower risk for subsequent mental health problems.

Pharmacological neuroenhancement and the ability to recover from stress - a representative cross-sectional survey among the German population

BACKGROUND

Pharmacological neuroenhancement (PNE) refers to the use of psychoactive substances without doctor's prescription to enhance cognitive performance or to improve mood. Although some studies have reported that drugs for PNE are also being used to cope with stressful life situations, nothing is known about the relationship of PNE and resilience, i.e. the ability to recover from stress. This study aimed at investigating the relationship of PNE and resilience in the first representative population sample.

METHODS

A cross-sectional survey in a representative sample of 1128 adults (age ≥ 18 yrs.) living in Germany was conducted. The use of PNE and related attitudes, perceptions and behaviours were assessed by structured interviews and self-report questionnaires. Stepwise logistic regression with backward elimination was conducted to identify potential risk factors for PNE use.

RESULTS

Lifetime prevalence for the use of stimulating prescription drugs without medical indication was 4.3%, 10.2% for stimulating illicit drugs, 20.3% for mood modulating prescription drugs, and 23.4% for cannabis. Coping with stressful situations was more frequently reported as underlying motive for using stimulant or mood modulating prescription drugs than stimulating illicit drugs or cannabis. The individual perceived stress increased the risk of using stimulating prescription drugs (OR: 2.86; 95% Cl: 1.49-5.46) and the individual ability to recover from stress decreased the risk of using any substance for PNE and especially mood modulating prescription drugs (OR: .62; 95% Cl: .47-.81).

CONCLUSIONS

The non-medical use of prescription drugs for PNE appears to be more prevalent in subjects who are less resilient to stress. Tailored resilience interventions that improve the ability to adapt to and recover from stressors may prevent the use of prescription medication for PNE. Further research should disentangle the association between psychological resilience and PNE as well as examine the efficacy of resilience interventions in the prevention of PNE.

Reducing Lethal Force Errors by Modulating Police Physiology

OBJECTIVES

The aim of this study was to test an intervention modifying officer physiology to reduce lethal force errors and improve health.

METHODS

A longitudinal, within-subjects intervention study was conducted with urban front-line police officers (n = 57). The physiological intervention applied an empirically validated method of enhancing parasympathetic engagement (ie, heart rate variability biofeedback) during stressful training that required lethal force decision-making.

RESULTS

Significant post-intervention reductions in lethal force errors, and in the extent and duration of autonomic arousal, were maintained across 12 months. Results at 18 months begin to return to pre-intervention levels.

CONCLUSION

We provide objective evidence for a physiologically focused intervention in reducing errors in lethal force decision-making, improving health and safety for both police and the public. Results provide a timeline of skill retention, suggesting annual retraining to maintain health and safety gains.

Opioid-Independent and Opioid-Mediated Modes of Pain Modulation

Pain is regulated endogenously through both opioid and non-opioid mechanisms. We hypothesized that two novel pain modulation tasks, one drawing on context/expectations and one using voluntary reappraisal, would show differing levels of opioid dependence. Specifically, we expected that naloxone would block context-related analgesia, whereas mental imagery-based pain reappraisal would be opioid-independent.A double-blind, placebo-controlled intravenous naloxone versus saline crossover design was used. Twenty healthy volunteers completed the two modulation tasks with acute heat stimuli calibrated to induce moderate pain. In the mental imagery task, participants imagined either a "pleasant" or a "comparison" scenario during painful heat. In the relative relief task, moderate heat stimuli coincided with visual cues eliciting relief from the expectation of intense pain, and were compared with moderate heat stimuli delivered under the expectation of non-painful warmth. Both "pleasant imagery" and "relative relief" conditions significantly improved ratings of pain intensity and pleasantness during saline treatment. Indeed, the target stimuli in both tasks, which had been calibrated to induce moderate pain, were rated as mildly pleasant. Furthermore, consistently with the main hypothesis, blocking endogenous opioid signaling with naloxone did not significantly affect imagery-induced regulation of pain intensity or pleasantness. In contrast, the relative relief-induced pain regulation (i.e., context/expectation) was blocked by naloxone. We conclude that endogenous opioid signaling is necessary for expectation-related relative relief analgesia, but not for pain reappraisal through mental imagery. These results support mental imagery as a powerful and clinically relevant strategy for regulating pain affect also in patients where endogenous opioid mechanisms might be compromised.SIGNIFICANCE STATEMENT Neurotransmitter systems in the human brain can be probed through antagonist drugs. Studies using the opioid antagonist naloxone have demonstrated that the brain relies on both opioid and non-opioid mechanisms to downregulate pain. This holds clinical relevance given altered endogenous opioid processes in many chronic pain conditions. The present study used a double-blinded, placebo-controlled naloxone blockage of endogenous opioids in healthy humans to show differential opioid involvement in two pain modulation tasks. Context/expectation-driven (relative relief-related) analgesia was blocked by naloxone. In contrast, pain reappraisal through mental imagery was intact despite opioid receptor blockade, suggesting opioid independence. These results support mental imagery as a powerful, clinically relevant strategy for regulating pain as it does not rely on a functioning opioidergic system.

[Resilience to mental disorders in old age]

BACKGROUND

Why does the aspect of aging justify a special survey of resilience to the development of mental disorders? Patterns of chronic stress burden change with age (e. g. disappearance of workplace-related stress, but increased risk of frequent chronic diseases). Moreover, capabilities and cognitive strategies of stress coping differ between young and older adults.

MATERIAL AND METHODS

The article summarizes relevant age aspects of resilience to mental disorders and evaluates the current knowledge concerning consecutive development of prevention strategies for avoidance of affective disorders and dementia.

RESULTS AND DISCUSSION

Stress-aggravating reduced cognitive functioning (especially executive problem solving) can be observed together with, probably stress-reducing, age-specific appraisal preferences (positivity effect) in older persons. Other age-specific aspects are resilience mechanisms against cognitive decline and dementia development despite cerebrovascular and neurodegenerative brain pathology-related conditions, which are referred to as cognitive reserve. Different cognitive reserve enhancing strategies can effectively contribute to dementia prevention.

A Systematic Review of Amenable Resilience Factors That Moderate and/or Mediate the Relationship Between Childhood Adversity and Mental Health in Young People

Background: Up to half of Western children and adolescents experience at least one type of childhood adversity. Individuals with a history of childhood adversity have an increased risk of psychopathology. Resilience enhancing factors reduce the risk of psychopathology following childhood adversity. A comprehensive overview of empirically supported resilience factors is critically important for interventions aimed to increase resilience in young people. Moreover, such an overview may aid the development of novel resilience theories. Therefore, we conducted the first systematic review of social, emotional, cognitive and/or behavioral resilience factors after childhood adversity. Methods: We systematically searched Web of Science, PsycINFO, and Scopus (e.g., including MEDLINE) for English, Dutch, and German literature. We included cohort studies that examined whether a resilience factor was a moderator and/or a mediator for the relationship between childhood adversity and psychopathology in young people (mean age 13-24). Therefore, studies were included if the resilience factor was assessed prior to psychopathology, and childhood adversity was assessed no later than the resilience factor. Study data extraction was based on the STROBE report and study quality was assessed with an adapted version of Downs and Black's scale. The preregistered protocol can be found at: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016051978. Results: The search identified 1969 studies, of which 22 were included (eight nationalities, study sample n range: 59-6780). We found empirical support for 13 of 25 individual-level (e.g., high self-esteem, low rumination), six of 12 family-level (e.g., high family cohesion, high parental involvement), and one of five community-level resilience factors (i.e., high social support), to benefit mental health in young people exposed to childhood adversity. Single vs. multiple resilience factor models supported the notion that resilience factors should not be studied in isolation, and that interrelations between resilience factors should be taken into account when predicting psychopathology after childhood adversity. Conclusions: Interventions that improve individual, family, and/or social support resilience factors may reduce the risk of psychopathology following childhood adversity. Future research should scrutinize whether resilience factors function as a complex interrelated system that benefits mental health resilience after childhood adversity.

[Internet-based resilience training and prevention of mental disorders]

BACKGROUND

Resilience is associated with a positive and resource-oriented perspective. Therefore, it seems especially attractive for health promotion and prevention. In recent years, interventions to foster resilience have been increasingly developed, which train resilience factors and are mainly conducted in a face to face group format.

OBJECTIVE

The question is raised what potential internet-based interventions (i-interventions) that train resilience factors have for health promotion and prevention.

MATERIAL AND METHODS

Based on a narrative overview, the possibilities for i‑interventions that train resilience factors for health promotion and prevention are investigated and the state of research is described.

RESULTS

The effects of the i‑interventions presented here, which aim at fostering resilience, on measures of mental health and well-being are heterogeneous and vary between low to high effects. Stronger evidence for the efficacy of these measures exists for more general i‑interventions that also train resilience factors but are conceptualized for the prevention of specific disorders, such as depression or for stress reduction.

DISCUSSION

Given the heterogeneous nature of intervention contents, theoretical foundations and therapeutic methods used, the heterogeneity of the evidence is discussed. In addition, perspectives for the further development of resource-oriented resilience interventions are outlined.

Diurnal and Reactivity Measures of Cortisol in Response to Intensive Resilience and Tactical Training Among Special Forces Police

Special Forces Police are called to the most dangerous situations that require skills and equipment beyond the training available to a patrol officer. We recruited a platoon of special forces (n = 18) and examined their basal and reactivity levels of cortisol in relation to occupational duties. Moreover, we measured the impact of a multiday program of intensive resilience and tactical training in improving cortisol responses to stressful situations. Participants were significantly more likely to exhibit basal cortisol levels higher than the civilian norms across all of the 5 days of intensive training. However, anticipatory cortisol, measured directly before exposure to critical incident scenarios, was significantly lower in Day 5 than in Day 1 of the training period. This study demonstrates that measuring cortisol is an objective method of examining training effects and possible long-term occupational health outcomes.

Population-based validation of a German version of the Brief Resilience Scale

Smith and colleagues developed the Brief Resilience Scale (BRS) to assess the individual ability to recover from stress despite significant adversity. This study aimed to validate the German version of the BRS. We used data from a population-based (sample 1: n = 1.481) and a representative (sample 2: n = 1.128) sample of participants from the German general population (age ≥ 18) to assess reliability and validity. Confirmatory factor analyses (CFA) were conducted to compare one- and two-factorial models from previous studies with a method-factor model which especially accounts for the wording of the items. Reliability was analyzed. Convergent validity was measured by correlating BRS scores with mental health measures, coping, social support, and optimism. Reliability was good (α = .85, ω = .85 for both samples). The method-factor model showed excellent model fit (sample 1: χ2/df = 7.544; RMSEA = .07; CFI = .99; SRMR = .02; sample 2: χ2/df = 1.166; RMSEA = .01; CFI = 1.00; SRMR = .01) which was significantly better than the one-factor model (Δχ2(4) = 172.71, p < .001) or the two-factor model (Δχ2(3) = 31.16, p < .001). The BRS was positively correlated with well-being, social support, optimism, and the coping strategies active coping, positive reframing, acceptance, and humor. It was negatively correlated with somatic symptoms, anxiety and insomnia, social dysfunction, depression, and the coping strategies religion, denial, venting, substance use, and self-blame. To conclude, our results provide evidence for the reliability and validity of the German adaptation of the BRS as well as the unidimensional structure of the scale once method effects are accounted for.

Resilience and Cognitive Function in Patients With Schizophrenia and Bipolar Disorder, and Healthy Controls

Background: This study compared adaptive resilience among patients with schizophrenia, bipolar disorder, and healthy controls, and examined the relationship of resilience to cognitive function. Methods: A sample of 81 patients diagnosed with schizophrenia, 34 with bipolar disorder, and 52 healthy controls completed the Connor-Davidson Resilience Scale (CD-RISC) and cognitive tests of verbal comprehension, executive functioning, and working memory. Paired comparison of diagnostic groups on CD-RISC and cognitive tests was conducted. Linear regression was used to identify the independent association of clinical diagnoses and neurocognition with resilience deficits. Results: Both patient groups showed significantly lower CD-RISC scores and poorer cognitive function than healthy controls and the schizophrenia group scored lower than bipolar group on these measures as well. CD-RISC scores were positively correlated with all three cognitive measures in the entire sample but not within the diagnostic subgroups. Multiple regression analysis showed differences in CD-RISC between diagnostic groups were not mediated by differences in these three measures of neurocognition. Discussion: Schizophrenia and bipolar disorder are associated with impairments in both resilience and cognitive function but the impairment in resilience appears to be independent of deficits in cognitive function measured here and may reflect unmeasured dimensions of cognitive function, other impairments or environmental factors.

Neuroimaging Correlates of Resilience to Traumatic Events-A Comprehensive Review

Improved understanding of the neurobiological correlates of resilience would be an important step toward recognizing individuals at risk of developing post-traumatic stress disorder (PTSD) or other trauma-related diseases, enabling both preventative measures and individually tailored therapeutic approaches. Studies on vulnerability factors allow drawing conclusions on resilience. Structural changes of cortical and subcortical structures, as well as alterations in functional connectivity and functional activity, have been demonstrated to occur in individuals with PTSD symptoms. Relevant areas of interest are hippocampus, amygdala, insula, anterior cingulate cortex, and prefrontal cortex, as well as related brain networks, such as the default-mode, salience, and central executive network. This review summarizes the existing literature and integrates findings from cross-sectional study designs with two-group designs (trauma exposed individuals with and without PTSD), three-group designs (with an additional group of unexposed, healthy controls), twin-studies and longitudinal studies. In terms of structural findings, decreased hippocampal volume in PTSD individuals might be either a vulnerability factor or a result of trauma exposure, or both. Reduced anterior cingulate cortex and prefrontal cortex volumes seem to be predisposing factors for increased vulnerability. Regarding functional connectivity, increased amygdala connectivity has been demonstrated selectively in PTSD individuals, as well as increased default-mode-network and salience network connectivity. In terms of functional activity, increased amygdala and anterior cingulate cortex activities, and decreased prefrontal cortex activity as a response to external stimuli have been associated with higher vulnerability. Increased prefrontal cortex activity seemed to be a protective factor. Selecting adequate study designs, optimizing the diagnostic criteria, as well as differentiating between types of trauma and accounting for other factors, such as gender-specific differences, would be well-served in future research. Conclusions on potential preventative measures, as well as clinical applications, can be drawn from the present literature, but more studies are needed.

The stress concept in gastroenterology: from Selye to today

More than eighty years after Hans Selye (1907-1982) first developed a concept describing how different types of environmental stressors affect physiological functions and promote disease development (called the "general adaptation syndrome") in 1936, we herein review advances in theoretical, mechanistic, and clinical knowledge in stress research, especially in the area of gastroenterology, and summarize progress and future perspectives arising from an interdisciplinary psychoneurobiological framework in which genetics, epigenetics, and other advanced ( omics) technologies in the last decade continue to refine knowledge about how stress affects the brain-gut axis in health and gastrointestinal disease. We demonstrate that neurobiological stress research continues to be a driving force for scientific progress in gastroenterology and related clinical areas, inspiring translational research from animal models to clinical applications, while highlighting some areas that remain incompletely understood, such as the roles of sex/gender and gut microbiota in health and disease. Future directions of research should include not only the genetics of the stress response and resilience but also epigenetic contributions.

Thriving on Pressure: A Factor Mixture Analysis of Sport Performers' Responses to Competitive Encounters

Although considerable research exists on performers' responses to sporting encounters, little is known about thriving in sport contexts. The current study examined if distinct response patterns existed between sport performers who thrived in competitive encounters compared with those who did not. Participants were 535 sport performers (134 women; M_age = 23.60 years, SD_age = 8.08; M_competing = 11.84 years, SD_competing = 7.11). Results of factor mixture analysis supported a four-profile solution comprising a thriving group (n = 146), a low-functioning group (n = 38), and two groups characterized by scores marginally above (n = 131) and below (n = 209) the sample mean. Profile membership was found to be predicted by personal enablers (viz., personal resilient qualities, psychological skills use) and process variables (viz., basic psychological need satisfaction and frustration, challenge appraisal). This examination of thriving in sport performers offers significant implications for research and practice.

Emotion Regulation Ability and Resilience in a Sample of Adolescents from a Suburban Area

Earlier research has identified a remarkable number of related factors to resilience during adolescence. Historically, theoretical treatments of resilience have been focused almost exclusively on psychosocial levels of analysis to derive explanatory models. However, there is insufficient understanding of the role of emotion regulation explaining competent functioning despite the experience of adversity (resilience), especially during adolescence. This study explores the relationship between both, emotional regulation abilities and strategies, and resilience in a sample of adolescents from suburbs high-schools (Jerez de la Frontera, Spain). The study also examines how using different emotional regulation strategies may help the development of resilience levels at this stage. Participants of the study were 164 adolescents ranging from 13 to 16 years old (M = 13.98; SD = 0.66). Emotion regulation was measured using the Cognitive Emotional Regulation Questionnaire (CERQ, Garnefski et al., 2001), and sections D and H of Mayer-Salovey-Caruso Emotional Intelligence Test, a performance test (Emotion Regulation Ability sections, MSCEIT, Spanish version, Mayer et al., 2003). Resilience was evaluated with ERE (Educative Resilience Scale for children and adolescents, Saavedra and Castro, 2009). Verbal Intelligence (Yuste, 1997) and personality traits (Cattell and Cattell, 1986) were assessed as two independent variables. Results supported the idea that emotion regulation ability (MSCEIT, D and H sections, Extremera et al., 2006) is a significant predictor of adolescents' resilience. Moreover, cognitive regulation strategies, such as positive reappraisal, predicted perceived resilience among students. Sociability (A factor of HSPQ, sociability) also correlated with resilience levels. Hence, these results are promising, implying that emotion regulation ability may act as a helpful tool preventing adolescents from irrational risky behaviors, commonly assumed at this developmental stage.

Intervention studies to foster resilience - A systematic review and proposal for a resilience framework in future intervention studies

Psychological resilience refers to the phenomenon that many people are able to adapt to the challenges of life and maintain mental health despite exposure to adversity. This has stimulated research on training programs to foster psychological resilience. We evaluated concepts, methods and designs of 43 randomized controlled trials published between 1979 and 2014 which assessed the efficacy of such training programs and propose standards for future intervention research based on recent developments in the field. We found that concepts, methods and designs in current resilience intervention studies are of limited use to properly assess efficacy of interventions to foster resilience. Major problems are the use of definitions of resilience as trait or a composite of resilience factors, the use of unsuited assessment instruments, and inappropriate study designs. To overcome these challenges, we propose 1) an outcome-oriented definition of resilience, 2) an outcome-oriented assessment of resilience as change in mental health in relation to stressor load, and 3) methodological standards for suitable study designs of future intervention studies. Our proposals may contribute to an improved quality of resilience intervention studies and may stimulate further progress in this growing research field.