Can You Think Yourself Well? Part II - Enhancing your resilience in adulthood

Can we build resilience in our adulthood? And if so, how?

Is our resilience level pre-determined by our genes? What makes some people more resilient than others and some more at risk and vulnerable to mental health issues than others? Can we build our resilience? And, if we can, which strategies really work?

An in-depth review of the scientific evidence shows that, while we are all born with greater or lesser natural resilience, there are important ways in which we can nurture what we have. Cultivating positive emotions, turning negative thought patterns into positive ones, and finding a sense of meaning and purpose in our lives have all been shown to help us cope better with adversity.

Through a thorough examination of the scientific literature, this article helps to identify what tools, techniques and practices really help us to think ourselves well, and it goes one step further: it asks why something works. Not only will this inform your curiosity, but if you have responsibility for policy or employees, it will also help you identify the most effective interventions.

Of course, evidence abounds about the importance for wellbeing of good diet, regular exercise and good sleep, but this article focuses on the evidence for psychological techniques and interventions that primarily enable us to build resilience in our mental and emotional health (such as symptoms of depression and anxiety, as well as stress-related conditions, such as PTSD and burnout).

What is resilience?

The term resilience conjures up ideas of bouncing back, of bending without breaking, of a certain steeliness and strength. In psychological literature, it is sometimes conceptualized as an individual trait or characteristic, which suggests it is something each of us has more of or less of than others. Resilience is also defined as a dynamic process of positive adaptation; a process that attenuates or prevents mental ill-health in the face of adversity or stress, and facilitates a swift recovery to normal mental-health function. 

Increasingly, we seem to view resilience as something more than bouncing back to where you were pre-adversity, encompassing instead a sense of growth (sometimes termed post-traumatic growth). This suggests that resilience incorporates some new learning that enables us to function at a higher level post-adversity.

There is, then, no single definition of resilience, but there are two important concepts to keep in mind for this article:

• trait resilience: a quality that some people have more or less of, and that we can measure.

• the process of adaptation to adversity, which may encompass an aspect of growth.

With these in mind, we can both acknowledge the reality of individual difference, but also the fact that we can improve and develop our resilience.

Who suffers from mental ill-health?

There is no doubt that some people are at greater risk of mental ill-health than others.

It’s in our genes

Latest research in genetics reveals that, perhaps unsurprisingly, our genes play a part in how resilient we are – we inherit variations of genes that can influence our potential for dealing with adversity effectively. We know, for example, that having a parent with depression or anxiety greatly increases our own risk factors for these conditions. However, the presence of these genetic variations does not guarantee the absence or presence of resilience. Nor does it guarantee that we will or won’t go on to develop depression. The emergent discipline of epigenetics provides many new insights into some of the mechanisms underpinning genetic predisposition (or not). Through the study of epigenetics, we know, for example, that our environment and experiences can influence whether or not the characteristics in our genetic makeup are expressed.

We know that our infant experiences are crucial when it comes to growing up resilient. In the 1950s, Bowlby and colleagues’ seminal and influential work on attachment revealed that, during our early years, secure attachments with our primary caregivers plays a crucial role in later mental health and resilience. Traumatic experiences in childhood – such as abuse, losing a parent, or accidents or illness – are also considered a risk factor for later mental health and yet many children adapt successfully or recover quickly from such trauma. We know, then, that there is no certainty that children who have experienced trauma will go on to experience mental-health issues in the short or long term. (For a more in-depth look at the role of early attachment on resilience in childhood, see our article ‘How to build resilience in children, adolescents and young adults’ https://www.thehumananalyticsproject.com/blog/can-you-think-yourself-well ).

Stress and brain function

As new scientific technologies develop in brain imaging, gene mapping and cellular biology, our understanding of the biology of the brain and nervous system has advanced dramatically, along with our understanding of how our biology influences our resilience. What emerges is that it is not simply a case of nature versus nurture, but a complex interplay between our biology (our genes, neurons, cells and hormones), our environment (our lifetime experiences and our social context) and our psychology (our personality and emotional disposition).

A complex set of circuits and regions within the brain plays a critical role in our ability to regulate our mood and emotions, and so is thought to be key for resilience. Two circuits are worth particular mention:

• The reward circuit, which has been linked to depression, involves the naturally occurring chemical dopamine. Low levels of dopamine have been associated with depressive symptoms such as low mood, decreased energy and reduced motivation. Modifying the reward system (such as through deep stimulation of the areas involved in the reward pathways) may improve symptoms. Boosting dopamine levels is exactly the purpose of some antidepressants, but it is possible to effect similar ‘mood boosts’ through non-pharmacological means?

• The fear or stress circuit, which is associated with anxiety and stress. A key structure that sits in the base of the brain, the amygdala is largely responsible for controlling how we respond to fear, through the release of stress hormones. When we perceive danger, the amygdala puts out a burst of stress hormones that elevates our arousal and blood flow, preparing us to take flight or to fight. While these temporary bursts are useful, when levels are elevated over prolonged periods of time (as happens in the cases of severe, chronic stress), the brain’s capacity to create new neurons is impaired and changes occur in the brain’s structures. Furthermore, we put strain on our heart, impairing our cardiac and circulatory functions.

The prefrontal cortex, a separate, more rational part of the brain that is responsible for planning, prioritising and taking action, is connected to the amygdala via neural networks. In fight-or-flight scenarios, the amygdala becomes hyperactive and switches off our rational brain, so that we don’t waste valuable time thinking through the pros and cons of escaping imminent danger. When the immediate danger has gone, the rational brain takes over again. Neuroimaging studies, which allow us to see detailed images of the brain’s structures and activity, reveal that chronically stressed individuals (such as those with PTSD) show hyperactivity of the amygdala and hypoactivity of the prefrontal cortex, with weakened connections between the two. This reduces the ability of the rational brain to exert control over the amygdala, causing feelings of chronic anxiety and distress. 

The interplay of our genetic predisposition and our experiences is likely to play a significant role in these changes to the brain’s circuitry, and so our emotional well-being. But while we cannot do anything about our genes, and there is little we can do about our upbringing and other aspects of our life experience, we now know that we can ‘train’ our brains to respond differently to them. The capability of the brain to develop and modify its neural circuitry – known as neuroplasticity – occurs throughout our lives and means we always have the potential to modify our brain’s functioning in response to stressors and adversity. Rather like physical training building muscles in the body, the right mental training can build ‘muscle’ in the brain.

The resilient personality

Psychological research has found that certain personality traits are linked to resilience. Individuals who have lower levels of neuroticism, higher extraversion, higher conscientiousness and higher levels of openness to change tend to be more resilient. They also tend to have higher self-esteem and to be more inclined to have an internal, rather than external locus of control – a belief they can influence their direction and fate rather than things happening to them by luck or chance. Crucially, they also experience positive emotions to a greater extent than less resilient people and have fewer depressive symptoms. These individuals are said to have higher levels of ‘trait resilience’. Resilient personalities regulate their emotions better than the less resilient by doing things such as catching and reframing negative thoughts, reaching out to support networks to share feelings and seek help, looking for the upsides and benefits in challenging situations.  The good news is that these are things that can be copied and practiced.

There is overwhelming evidence that, no matter our predispositions or experiences, we can still cultivate and develop resilience. Indeed, one leading resilience theorist, Ann Masten suggests resilience is actually a common human characteristic and has termed it ‘Ordinary Magic’.

Routes to building resilience

Breaking habits -– ‘reprogramming’ negative thought patterns

It is well established that unhelpful and negative thought patterns – such as catastrophizing and holding a negative attentional bias – are hallmarks of anxiety and depression. Cognitive behavioural models (the basis of cognitive behavioural therapy – CBT) see depressed individuals as holding distorted beliefs formed earlier in their lives (for example, an irrational belief ‘I am unlovable’, perhaps formed as a result of cold and critical parenting). These beliefs get triggered by later events (such as the break-up of a romantic relationship), leading to irrational, negative thoughts and unhelpful patterns such as catastrophizing (‘I will never have a successful relationship’). Excessive rumination serves to maintain these thoughts (that sense of going over the same thoughts without moving forwards), and the associated negative emotions. 

In effect, the brain’s activity becomes ‘stuck’ in the fear/stress circuit. A vicious cycle of habitual negative thinking becomes the norm, and the rational, problem-solving part of the brain is suppressed. CBT techniques aim to break this cycle, replacing negative thoughts with more positive ones, challenging negative assumptions and finding benefits or ‘silver linings’ from otherwise unpleasant situations (for example, seeing an opportunity to get fitter and heathier following a serious illness). 

Neuroimaging evidence supports the short-term benefits of CBT techniques to combat these negative patterns, showing increased activity in the prefrontal part of the brain and decreased activation in the amygdala in response. CBT techniques have been widely used in preventative programmes with at-risk groups, such as those with a history of depression; or those showing depressive symptoms but not yet meeting the level for a clinical diagnosis. However, there are no magic, quick fixes when it comes to changing ingrained patterns of thinking – and it seems that individuals may need top-up or booster sessions to ensure changes stick. 

A word of caution: a lack of published controlled scientific studies means that it’s hard to determine how much of the reported success of these interventions is due to the CBT techniques or to other factors, such as the skill of the therapist, or of other techniques (such as mindfulness) that often run alongside.

Creating habits – experiencing positive emotions and finding reward boosts

There is now a significant body of evidence to show that resilient people experience positive emotions – joy, happiness, love and contentment, for example – to a greater extent than less resilient people, and that positive emotions have an adaptive function, enabling swifter recovery from adversity. 

While resilient individuals may have increased protective resources afforded them through the greater experience of positive emotions, it appears that at times of stress, positive emotions become particularly important for less resilient individuals. Importantly, positive emotions are independent of negative emotions (that is, they are not two ends of a spectrum) and can co-occur. For example, think how, following a crisis, you might be anxious and scared, but also grateful to be alive or appreciative of loved ones. Positive emotions are associated with raised dopamine levels, providing reward boosts and a ‘feel-good’ lift in the moment. Enabling a faster return to cardiovascular baseline following negative arousal and stress, they benefit our physical as well as mental wellbeing. 

The ‘Broaden and Build’ theory offers one explanation for how positive emotions can help build resilience: in contrast to negative emotions (such as fear or anger), which narrow and limit our available options and range of responses, positive emotions (such as love, interest and enjoyment) serve to open up possibilities and broaden our thinking, which over time helps build physiological, intellectual and psychological resources, providing internal strength to draw upon in future adversity. 

The horrific terrorist attacks on the US on September 11th 2001 caused fear, anger, distress – and not only to those directly affected. Fredrickson et al (2003) measured the positive and negative emotions pre and post the attacks in a group of New Yorkers. Those with higher resilience scores (measured prior to the attacks) were found to be less likely to experience depressive symptoms after the attacks and they experienced positive emotions more frequently, and negative emotions less frequently than their less resilient counterparts. They were more likely to thrive following the attacks, experiencing higher levels of optimism, life satisfaction and tranquillity – in other words, they experienced some aspects of post-traumatic growth. So, we can conclude that positive emotions provide a buffer in times of and following crises – and they are a core ingredient of resilience.

Aside from crisis situations, studies show that day-to-day positive emotions (such as appreciating nature, laughing at a joke or enjoying a compliment), termed ‘reward experiences’, act as a protective mechanism against depressive symptoms when faced with a stressful life experience. These benefits not only continue into later life, but also occur for at-risk or vulnerable groups who have suffered significant childhood trauma. Twin studies show that positive daily emotional experience can attenuate the increased risk of depression from genetic predisposition too. Increases in reward experience also predict recovery from depression, which implies that the ability to boost our positive emotions can change and is not set in stone. 

Positive psychology interventions (PPIs)

The relatively new discipline of positive psychology, most associated with psychologist Martin Seligman, describes a number of interventions that aim to cultivate positive feelings, behaviours or thoughts as a means to boost wellbeing and relieve suffering. Examples include: writing gratitude letters, defining life goals and values, focusing on personal strengths, counting blessings, savouring positive experiences in the moment to prolong them, replaying positive memories and experiences, and socialising. These interventions are said to be particularly effective for addressing a lack of positive emotion and life purpose, which can characterize depression. Studies with the elderly have found that reliving happy memories during family visits led to reduced symptoms of depression, compared with visits only. Analysis shows that longer interventions tend to be more effective than shorter ones, illustrating the importance of repetition and habit-forming when bringing about lasting behaviour change. 

Mindfulness and developing a mindful disposition

Mindfulness-based techniques and therapies are gaining increasing acceptance as a way to treat mood-related mental health conditions but they are also seen as an effective tool for boosting resilience. But is mindfulness worthy of all the hype?

Evolved from meditation, mindfulness encourages you to focus on the present and to notice, but let go of your thoughts without judgement or evaluation. Greater awareness in the moment is said to expand attentional focus, and awareness of both positive and negative emotions. Entering into this metacognitive state – known as decentering – is believed to be a mechanism for stopping excessive rumination and semantic processing and for increasing the cognitive flexibility we need for positive reappraisal. In effect, we access a more resourceful state of mind, which in turn leads to reduced stress and increased resilience. The combination (which in effect this is) of mindfulness and CBT, forms the basis of several newer therapies, such as mindfulness-based CBT (MBCBT) and mindfulness-based stress reduction.

Mindfulness practice has been shown to have an inverse relationship with rumination – and also with depressive symptoms. Neuroimaging studies show that long-term mindfulness practice brings about structural changes in the brain, reflecting the formation of new neural networks and changes to the areas of the brain involved in emotion regulation. It seems feasible, then, that sustained mindfulness practice may build a cognitive and emotional system that helps more positive thoughts and emotions counter the self-perpetuating and damaging cycles triggered by negative emotions, and that this might be one of the keys to fostering resilience. It also appears that having a mindful disposition (which can be measured via a specific questionnaire) has similar benefits to the practice of mindfulness itself.

Acceptance as a therapeutic approach

Avoiding or suppressing unwanted internal experience has repeatedly been linked to negative wellbeing. While avoidance might reduce negative thoughts and feelings in the short term, it gradually increases unwanted inner experience in the longer term – leading to depression and anxiety. Think of a new mother, for whom it is completely normal to experience a range of both positive and negative emotions (joy, but also anxiety; love, but also ambivalence). The predominant societal expectation is that new motherhood should be a time of pure bliss. This dissonance can lead to new mothers finding it hard to accept their internal experiences and, as a result, they may use maladaptive avoidance strategies (such as avoiding contact with other new mothers), self-criticism (‘I’m incompetent’) or negative appraisal of their thoughts (‘good mothers don’t feel this way’) to cope. In a study of postpartum women considered at risk of developing postpartum depression, Monteiro et al (2019) found that women who don’t report symptoms of depression or anxiety had higher levels of psychological flexibility, non-judgemental appraisal of thought content, and greater levels of self-compassion than those that did.  

The notion of psychological flexibility (defined as ‘the ability to notice and experience thoughts and feelings, without trying to control or avoid them, while acting in a way that is consistent with one’s values’ – Hayes et al 2006) is core to Acceptance and Commitment Therapy (ACT), a relatively new therapy evolved from CBT. ACT has shown some promise in building resilience, with a number of studies reporting that employing ACT-based strategies can lead to fewer depression and anxiety symptoms. In short, ACT consists of a number of processes, including acceptance (rather than denial or suppression) of one’s inner experience, greater attention on the present (that is, being mindful), as well as values-based goal-setting and commitment to action – that is, behavioural activation and change. In contrast to CBT, the therapy doesn’t call for us to change the content of our inner experience. Instead, acceptance and mindfulness reduce the negative impact. 

Loving kindness and compassion

Therapies based on developing loving kindness and compassion have been found to increase and strengthen levels of positive emotions in daily life, and to decrease negative effect in response to stressful situations. As with ACT, compassion-based approaches do not try to change or ignore the negative reality, and it has been suggested as a promising strategy preventing burnout in professions exposed to high levels of personal distress, such as frontline healthcare and social workers. 

Purpose, meaning and spirituality

We mentioned earlier post-traumatic growth, which is often described as finding new purpose and meaning to life, particularly following trauma or stress. The study of the New Yorkers who experienced the 9/11 attacks demonstrates this, but it’s also shown in studies of cancer survivors: those with a higher level of dispositional mindfulness were more likely to attend to positive emotions, in turn associated with a positive appraisal of life events and with finding an increased sense of meaning in life and general life satisfaction. Victor Frankl, the psychiatrist and concentration camp survivor developed a theory predicting the survival chances of his fellow prisoners by observing their capacity to find meaning in their current situation. He proposed people can find meaning and life purpose in any situation, but that psychological problems occur when the search is unsuccessful.

For those with spiritual or religious belief, connection to something greater than oneself or identification with a set of religious beliefs may act to guide and steer one through life and its challenges. Scientific study repeatedly shows a relationship between religiosity/spirituality and resilience, and it has been suggested that greater religiosity/spirituality may act as a protective factor against depressive episodes. Measures of spirituality have been shown to correlate inversely with negative emotions such as neuroticism, with more spiritual individuals reporting a greater likelihood of successfully managing emotions, such as anger and anxiety. It seems quite possible that spirituality/religiosity may promote feelings of compassion, gratitude and love – positive emotions – that then allow for a broadening of attention and perspective leading to a deeper understanding of what is of important.

What can we learn from highly resilient people?

As you would expect, some of the qualities of trait resilience – being adaptive and open to change, taking responsibility, maintaining a sense of control over actions and decisions, and taking the time for activities that bring joy and serenity – are evident in individuals who operate in high-stress environments (senior politicians, company CEOs, top sportspeople, for example). However, interestingly, an emerging theme demonstrates that these thriving individuals have sought out and embraced opportunities for personal growth; they have relished new challenges that we could say bring some ‘stress inoculation’.

We know that setbacks can bring opportunities for growth and learning. Embracing those opportunities is something resilient people do naturally; less resilient people are more fearful and cautious, and so potentially miss out. The capacity to reflect on difficult experiences and to learn from them, and then to incorporate this learning into future experience, is an important component of resilience – and effective not just during childhood, but during adulthood too. 

The stress-management programme Stress Inoculation Training (SIT), combines psychoeducation and understanding of our own stress and triggers, CBT skills and an inoculation component. This provides participants with coping strategies and increased confidence through exposure to minor stressors. Participants practise dealing with potentially stressful scenarios using imagination, role play and feedback, then they go out and face the real thing. Initial results have been positive, but (as is so often the case) it is impossible to tease out which specific ingredients in the programme contribute to this effectiveness. We simply can’t tell how much success is down to CBT and how much to stress inoculation.

One effective ‘ingredient’, though, is likely to be the support each individual receives from the trainers and, for group-based therapies, other participants. Going back to our population of thriving, high performers, a common factor is the use of networks, mentors and other key relationships. Indeed, available social support has consistently been shown to be important for building resilience; and the absence of it, a significant risk factor for poor mental health.

So, what do we really know?

Our journey through the scientific literature hasn’t provided conclusive evidence for all our questions. But, what we do know is that there are some practical things we can do to build resilience, even when our genetics, circumstances or experiences seem to disadvantage us. Resilience is not fixed; we can nurture and develop it using a range of psychological interventions that target different psychological processes – we just still don’t know with certainty the relative effectiveness and impact each of them has. In conclusion, then:

• We can build resilience just as we can build a muscle, but this means cultivating sustained practices over time. There are no quick fixes.

• Experiencing positive emotions is a key ingredient of resilience and more resilient people experience these to a greater extent than less resilient people. Finding increased opportunities to boost daily reward experiences has a positive impact.

• Developing a mindful disposition results in a greater internal resource to draw upon during stressful times, and may also facilitate greater attention and access to positive emotions.

• Finding ways to work in alignment with our values builds resilience and protects from depressive symptoms. This is likely to help achieve a greater sense of purpose and meaning to life, itself an ingredient for greater resilience.

• Spirituality and/or religiosity are associated with resilience and fewer depressive symptoms and may also be associated with positive emotions, which we know are an important ingredient of resilience.

• Challenging negative thought patterns can help break a negative attention bias, better regulate emotions, and engage the more resourceful, problem-solving part of the brain.

• Accepting our feelings and inner experiences, rather than judging or suppressing them, and adopting greater compassion and kindness (towards self and others) can each lead to better mental health outcomes.

• Highly resilient people find ways to seek out and embrace new challenges and experiences, reflect on and learn from ‘failures’ and implement any learning into future experiences. 

• Having available social support is important, whether that is through friends, family, support groups, mentors, or peer groups. Social support mitigates risk and helps protect mental health.