Newsletter September 2013

Scientific American Mind on Resilience

The July-August 2013 issue of Scientific American Mind features a cover story on resilience: “Ready for Anything.

The authors, Steven Southwick and Dennis Charney, draw on research presented in their book Resilience: The Science of Mastering Life’s Greatest Challenges, published by Cambridge University Press in 2012.  They say early on in the article, “A resilient person may bend but does not break when confronted with adversity, enabling him or her to bounce back relatively quickly.”

My book Bouncing Back: Rewiring Your Brain for Maximum Resilience and Renewal, reports on neuroscientific discoveries about the impact of relational psychology and mindfulness on resilience; this article reports more on research in the behavioral sciences and the empirically-based strategies of cognitive-behavioral therapy.  And strategies in this article focus primarily on reducing the stress response, one of the 6 C’s of coping (Calm) offered in Bouncing Back. “Biologically, resilience is the ability to modulate and constructively harness the stress response.”  Nonetheless, there is much common ground, many fascinating parallels and substantial usefulness in the clarity of this cover story.

May these reflections and exercises on bending but not breaking be useful to you and yours.

Reflections

The authors use the American Psychological Association’s definition of resilience: “The process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress.”

They acknowledge the impact of genetic and environmental factors beyond an individual’s control:

“Whether a person hangs tough or gives up in hard times depends on influences at multiple levels, from molecules to neighborhoods.  Resilience is determined by both inborn traits and environmental factors that affect the capacity to adapt to stress. Environmental variables such as family support, stability and quality of schools, the services in and safety of a neighborhood, availability or lack of financial resources contribute to – or compromise – our responses to adversity.”

And they prioritize, as the recent discoveries of self-directed neuroplasticity would lead us to, the opportunities an individual has to increase his or her level of resilience by developing mental and physical habits that foster positive adaptation to stress and trauma.

“Virtually anyone can become more resilient through disciplined, consistent practice.  The more we activate specific brain areas through our behavior, the more neural connections form in those areas, enabling the neurons involved to transmit their messages more efficiently. ”

They suggest six strategies for boosting resilience:

1.  Reinterpreting or reappraising the meaning of negative events,

In cognitive-behavioral therapy, a person is taught to observe their thoughts and behaviors, challenge any negative assessments of both stressful situations and of themselves in meeting those situations, and replace negative or doubting stances with more realistic and positive points of view.  “Is there a less destructive way to look at this situation?”  “Is there something that I can learn from this experience, or is it possible to grow stronger as a result?” are examples of the reappraisal process.

The authors specifically suggest a technique of cognitive-bias modification, learning to deliberately tune out automatic negative interpretations of a situation and develop a new habit of allowing ambiguous situations to be interpreted in a more positive manner.

Looking at the glass as half full rather than half-empty increases activity in the pre-frontal cortex, the brain’s center for planning, directing and inhibiting behavior, and decreases activity in the amygdala, the brain’s hub for the threat/stress response.  The “left shift” found particularly the left pre-frontal cortex is associated with greater emotional control, and faster recovery from feelings of anger, disgust and fear.

The authors cite a 2008 study of 30 former Vietnam prisoners of war.  When these veterans could actively reappraise their imprisonment, even when they had experienced torture, and could find meaningful ways in which they had grown stronger, wiser and more resilient because of their experiences, they were now better able to see possibilities for the future, relate to others well, and appreciate the gifts of life.

Interestingly, the authors do recommend mindfulness meditation as a practice that supports cognitive reappraisal (as in mindfulness-based therapy for depression).  As a practice of consciously living in the present moment, rather than dwelling on the past or fretting about the future, mindfulness helps a person observe, but not judge, as the mind tends to automatically follow familiar conditioned patterns of thinking that often add to distress and maladaptive coping.  Research has found correlations between mindfulness and improved ability to focus, better ability to cope with depression, anxiety and stress, more flexible thinking, and greater psychological well-being, thus more resilience.

2.  Regulating emotions, especially enhancing positive emotions, adopting a positive but realistic outlook.

Negative emotions, while evolutionarily adaptive for quick, life-saving responses to stress and threat, thus helping us stay alive to cope another day, increase physiological arousal, narrow our focus of attention, and restrict behaviors to those necessary for survival.  Positive emotions reverse the process, reducing physiological arousal and broadening our focus, leading to more creative and flexible responses to stress and trauma.  (See July 2012 e-newsletter “Positive Emotions Build Resilience” for more.)

This broadening of focus leads to realistic optimism.  The authors are careful to point out that this is not an overly buoyant, rose-colored outlook that would ignore negative information and underestimate the risk in stressful situations.   They have found that realistically optimistic people filter out unnecessary negative information but pay close attention to bad news that is relevant to dealing with adversity.

The authors note that reducing distress, enhancing well-being, fostering more optimism through  positive emotions strengthens resilience and are strongly associated with good mental and physical health.

“A dedicated effort to bolster positive emotions can enhance a person’s ability to bounce back from difficulty.”

3.  Becoming physically fit

Research has demonstrated for some time that aerobic exercise suppresses the release of the stress hormone cortisol, reduces symptoms of anxiety and depression, and increases the release of the endorphins that boost energy and promote a sense of well-being.  Research is also demonstrating that aerobic exercise improves attention, planning, decision making and memory, empowering people to better deal with trauma and tragedy.  (See the December 27, 2012 Resources for Recovering Resilience Running Makes Your Brain Smarter.)

Workouts seem to activate genes for proteins, such as brain-derived neurotropic factor (BDNF), that promote the growth and repair of neurons, which prolonged stress can damage.  Moderate- intensity aerobic exercise increases the size of the hippocampus, a brain region involved in both memory and stress regulation, which helps people recover from difficult circumstances.

The authors suggest every workout should be challenging but manageable.  This way, in addition to getting the biological benefits of the exercise itself, you are also carefully calibrating your exposure to stress in a way that is known to increase resilience.

4.  Accepting challenges

We can strengthen our capacities to respond adaptively to stress by choosing to take on novel tasks, to interact with unfamiliar people, and cultivate a baseline self-acceptance that includes accepting our flaws, faults, and failures.

To do this, the authors suggest a strategy of “stress inoculation,” similar to increasing resilience through increasing the intensity of a workout as described above.   When a person deliberately takes on increasingly difficult life challenges, he or she will gradually learn to handle the higher levels of stress involved.   The authors suggest the challenges be in the sweet spot outside of your comfort zone but not so intense as to be unmanageable or potentially harmful. And then, as with a physical workout, you plan to progressively intensify the difficulty of these endeavors, inoculating yourself against stress and increasing your resilience.   They also emphasize how important it is to balance out stress exposure with relaxation and recovery, just as in a physical workout.

5.  Maintaining a close and supportive social network

Especially in situations of extreme adversity, high levels of social support significantly lower levels of post-traumatic stress disorder.  The authors cites studies that show this significant reduction of PTSD among soldiers returning from war, survivors of sexual abuse, people coping with illness and death, even coping with the stresses of unemployment and parenting.

Even when not coping with potentially traumatizing events, close relationships dampen our biological response to stress, bolster our belief that we can overcome obstacles, and bolster our courage in tense situations.  With the support of others, we tend to feel more self-confident and become more active problem solvers rather than passively avoiding challenges.

The authors do mention my favorite factor in relationships promoting resilience: that close social bonds activate the release of oxytocin, the hormone of trust and belonging that reduces the release of the stress hormone cortisol and allows us to feel more safety trust, and resilience.

6.  Observing and imitating resilient role models

Within and beyond our personal networks of social support, the authors reiterate the importance of identifying people who recover quickly from hardship that you could learn from.  Even beyond the family, friends, colleagues, teachers, coaches that we know personally, finding role models of resilience among athletic, historical, and literary figures.

The authors tie all six strategies together in a sidebar on the biology of bouncing back:

“Critical to building resilience are the capacities to face fears, experience positive emotions, search for adaptive ways to reframe stressful events, and benefit from relationships.  Thus, resilience relies on neural circuits governing fear, reward, and social and emotional regulation.  These circuits overlap at certain brain structures.  For example, the amygdala not only regulates fear but also plays a role in reward, through the processing of positive emotions.  The nucleus accumbens, the hub of reward, also influences social behaviors such as sociability and pair bonding.  The medial prefrontal cortex has a role in all three circuits, helping to regulate social interactions and emotions and relaying that information to other regions to inform higher-level decisions.  As a result of the overlap and connections among these circuits, how a person faces fear is correlated with his or her ability to remain upbeat under stress and generate rewarding social experiences in tough times.

“Resilience may also be related to activation of the left prefrontal cortex.  When active, this region at the surface of the brain just behind the forehead sends inhibitory signals to the amygdala, quieting anxiety and fear-based emotions and leaving the frontal brain regions free to plan and set goals.  In this way, a person  is better able to persevere, maintain a positive self-image, remain hopeful in stressful times, and plan and act without being overwhelmed by fear and other emotions.”

Poetry and Quotes to Inspire

Difficulty that can be mastered facilitates growth, self-esteem, self-efficacy and resilience.  A resilient person is thus not someone who avoids stress but someone who learns to tame and master it.
– “Ready for Anything”, Scientific American Mind, July-August 2013

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More than education, more than experience, more than training, a person’s level of resilience will determine who succeeds and who fails.  That’s true in the cancer ward, it’s true in the Olympics, and it’s true in the boardroom.
– Dean Becker, Harvard Business Review

* * * * *

Setbacks are part of any endeavor, and those who react to them productively will make the most progress.
– “Ready for Anything,” Scientific American Mind, July-August 2013

* * * * *

The art of living lies less in eliminating our troubles than in growing with them.
– Bernard M. Baruch

* * * * *

The problem is not that there are problems. The problem is expecting otherwise, and thinking that having problems is a problem.
– Theodore Rubin

* * * * *

There are more things to alarm us than to harm us, and we suffer more often in apprehension than in reality.
– Seneca

* * * * *

Worry gives a small thing a big shadow.
– Swedish proverb

* * * * *

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You must do the thing which you think you cannot do.
-Eleanor Roosevelt

* * * * *

Let me not pray to be sheltered from dangers, but to be fearless in facing them. Let me not beg for the stilling of my pain, but the heart to conquer it.
– Rabindranath Tagore

Stories to Learn From

The authors illustrate some of the strategies offered in “Ready for Anything” through the story of Jerry White who, while studying at Brown University, spent his junior year abroad studying in Israel.  On a sunny day during the Passover holiday in April 1984, White and two friends set out for a camping trip in the Golan Heights.  Suddenly, innocently, White stepped on a landmine; the explosion blew his left foot completely from his body.  His friends wrapped his stump with a shirt, tied a makeshift tourniquet around the injured leg, and carried him through what they now knew was a minefield.

White lived in two Israeli hospitals for the next four months. Eventually White returned home, completed college and worked as a substitute teacher.  Years of soul searching (labeled as cognitive reappraisal by the authors) led him to become an activist working on behalf of fellow victims.  In 1995, he and his friend and colleague ken Rutherford, who lost both legs to a land mine in Somalia, founded the landmine Survivors Network (now known as the Survivor Corps).  The passion and sense of mission in the group played a leading role in the International Campaign to Ban Landmines, which was awarded the Nobel Peace Prize in 1997.

A much, much more modest example is one of my own stories that I tell in Bouncing Backto illuminate the possibilities of reappraising experience and developing a more positive outlook.

I was deep in a worrisome thought one day, not paying attention to where I was walking, when I blithely stepped ankle-deep into the wet cement of a freshly laid crosswalk. I was startled, then horrified. Negative reactions started cascading inside me, including, “How careless! How could you have been so asleep at the wheel!” I was just about to fall into an all-too-familiar pattern of berating myself for being so clumsy when another inner voice piped up, “Wait a minute! So I was preoccupied! I’m sick and tired of winding up feeling lousy about myself when I was just unconscious for a moment. For once I’d like to just deal with something and not make it all about my being clumsy.”

I stood there in the cement, noticing all these different reactions cascading. Years of practice helped me realize I did have a choice about how I was going to handle the situation. I lifted my

feet out of my stuck shoes and stepped onto dry ground as construction workers headed over to help me. As I lifted my shoes out of the cement, I tried for a little bit of compassion for myself. “Shit happens! I’m probably not the only person on the planet who made a mistake today because I wasn’t paying attention. Sure, I’m a little embarrassed in front of these guys, but that doesn’t mean anything more about me than I just wasn’t paying attention.”

I walked over to a convenient outdoor faucet on the wall of a nearby apartment building to wash my shoes and feet. As I began to have some hope that I might even save my shoes (I did), I noticed feeling some pride that I was coping well – with the outer event and with my inner reactions to it.

By the time one of the construction workers gave me some paper towels to dry my shoes and feet, my prefrontal cortex got it together and it dawned on me: “Yes, shit happens. Life is happening in this way in this moment. But ‘shift’ happens, too.” I could open to the lesson of the moment: choosing to shift my perspective allowed me to cope resiliently. The experience also taught me, once again, that shifting perspectives and responding resiliently is possible in any moment at all.

Exercises to Practice

Because close and supportive social ties are so essential to strengthening resilience, the authors suggest creating a list or a map of people you are connected to that you could turn to for understanding, advice, knowledge, and help.  I would sophisticate the list by identifying situations in life where our resilience might be challenged –  health, finances, relationships themselves – and then identifying people who could be resources in those specific areas. One important factor in strengthening ties with people who can help us through tough times is our own willingness/capacities to become resources in whatever realms we can to other people as well.

Another way to cultivate a sense of safety net that is so important to resilience is to become aware of – and grateful for – people we may not know very well at all, or may never even meet, who help keep our lives going:  the people staffing your local hospital right now, in case you slip on a rug on the way to the bathroom, break a bone in your foot or wrist, and have to be rushed to the emergency room.  You might include people staffing airports, pharmacies, fire stations, gas stations, those testing water quality at the municipal reservoir so that when you turn on the kitchen faucet you have drinkable water to drink.  (For years my brother Barry was on call in his home town to drive the snow plow at 3am so folks could get to work at 7am.  I know how deeply he appreciated being appreciated for that humble service.)  Practice gratitude for the people growing our food and recycling your garbage, for the entire web of life that keeps our life going, moment to moment to moment.

Resources

Reading for Anything,” by Steven Southwick and Dennis Charney.  Scientific American Mind, July-August 2013.

Resilience: The Science of Mastering Life’s Greatest Challenges by Steven M. Southwick and Dennis S. Charney.  Cambridge University Press, 2012

Dr. Southwick is professor of psychiatry, PTDS and resilience at the Yale University School of Medicine.  Dr. Charney is professor of psychiatry, neuroscience, pharmacology and systems therapeutics at the Icahn School of Medicine at Mount Sinai.

Other articles they recommend:

Being in the Now.  Amishi P. Jha, Scientific American Mind, March-April, 2013

The Essence of Optimism.  Elaine Fox.  Scientific American Mind, January-February 2013.

Coping Changes the Brain.  Jordan M. Nechvatal and David M. Lyons in Frontiers in Behavioral Neuroscience, vol. 7, no. 13. Published online February 2013.