COMMENTARY

Stress and Resilience: Implications for Depression and Anxiety

Jerrold F. Rosenbaum, MD; Jennifer M. Covino, MPA

Disclosures

December 29, 2005

In This Article

Resilience to Stress (Grand Rounds Presentation)

On Friday, September 23, Dennis Charney, MD, Dean of Research and the Anne and Joel Ehrenkranz Professor of Psychiatry and Neuroscience, Pharmacology, and Biological Chemistry at Mount Sinai School of Medicine in New York City, delivered a grand rounds presentation entitled: "The Psychobiology of Resilience to Extreme Stress: Implications for the Prevention and Treatment of Mood and Anxiety Disorders."

Dr. Charney began by discussing his current research, in collaboration with Dr. Steve Southwick, which focuses on the study of individuals who have been exposed to extreme stress and have shown remarkable resilience. Their goal is to ascertain why one person appears more resilient than another. A major source of the data are Vietnam veterans who did not develop either depression or PTSD after being held as prisoners of war (POW). This group consists of approximately 750 men, primarily pilots, all of whom were held captive during the Vietnam War, held for a period of 6-8 years, tortured, and/or kept in solitary confinement. The research conducted on this population of individuals has included video taped interviews, neuropsychological testing (including tests of emotional intelligence), neuroimaging, and DNA studies.

Dr. Charney identified 10 critical psychological elements and characteristics of resilience, including:

  1. Optimism. Those who are extremely optimistic tend to show greater resilience, which has implications for cognitive therapies that enhance a patient's positive view of his or her options, thereby increasing optimism;

  2. Altruism. Those who were resilient often found that helping others was one way to handle extreme stress, which can also be used therapeutically as a recovery tool;

  3. Having a moral compass or set of beliefs that cannot be shattered;

  4. Faith and spirituality. For some POWs, prayer was a daily ritual, although others were not at all involved or interested in religion;

  5. Humor;

  6. Having a role model. Many people with role models draw strength from this; for treatment, using a role model, role modeling, or helping someone discover a role model can be beneficial;

  7. Social supports. Having contact with others who can be trusted, either family or friend, with whom one can share most difficult thoughts was important in recovery;

  8. Facing fear (or leaving one's comfort zone);

  9. Having a mission or meaning in life; and

  10. Training. One can train to become a resilient person or to develop resilience by experience in meeting and overcoming challenges. Dr. Charney believes the importance of training has implications for how we prepare young people for adulthood. He suggested that high school health courses could be adapted to help with this preparation.

After illustrating these characteristics of resilience, Dr. Charney turned to research tools including genetics and neuroimaging. One of the major limitations of research on adaptation to stress is that patients typically present after the stress has occurred, rendering prospective study more difficult. Poststress differences also raise questions of what is a trait (innate) vs what is a state (caused by the stress or trauma). He cited 2 specific studies being conducted to address this issue by looking at groups about to undergo severe stress, specifically the US Special Forces and the Navy Seals in training. This work, conducted in collaboration with Dr. Andy Morgan at Yale, focused on the US Special Forces and allowed researchers to obtain pre-, during, and post-stress assessments. As might be expected, this group tended to evince extreme resilience, partly because of the self-selection process for special forces training. Dr. Charney described one training experience that involved trainees being taken into the North Carolina wilderness and hunted by a mentor or supervisor, placed in a mock prisoner of war camp, and stressed both psychologically and physically. Trainees were then graded on their performance.

Dr. Charney summarized the biological data from both the US Special Forces and the Navy Seals. During the interrogation or stress phase, cortisol levels, neuroepinephrine levels, and neuropeptide Y levels were found to substantially increase. Neuropeptide Y is an anxiolytic neuropeptide that interacts with and has been shown to counteract the effects of neuroepinephrine (which is anxiogenic) in multiple animal studies. One theory of resilience has implicated the role of a robust neuropeptide Y response in relation to a neuroepinephrine response, to counteract the impact of neuroepinephrine. Another neurochemical finding involves the interactions between dehydroepiandrosterone (DHEA) and cortisol. DHEA is an adrenal steroid that has been shown in animal models to counteract the effects of cortisol. Similar to the hypothesis of a robust neuropeptide Y response to neuroepinephrine, a robust DHEA response in relation to cortisol response may also play a role in resilience. In both groups, the higher the DHEA-to-cortisol ratio and the higher the response of neuropeptide Y in relation to neuroepinephrine, the better the performance rating during the stressful component of the training course.

Dr. Charney briefly cited other examples of neurochemical interactions within the literature. One animal study has shown that lower levels of testosterone may attenuate stress-induced responses in adrenocorticotropic hormone.[9] Another study supported the conclusion that emotional memory depends on post-learning adrenergic modulation.[10] He also mentioned the role of serotonin, citing recent work on the encoding of traumatic memories and the 5-HTT (serotonin transporter) gene (discussed above).

When considering the impact of stress, Dr. Charney recognized that there is a network by which stress-related neurochemicals are interactive and regulate one another. Future work should examine the patterns of response among these diverse neurochemical systems that respond to acute stress to grasp a full understanding of why one person is more resilient than another.

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