Stress-related mental disorders are the most prevalent and cost-intensive disorders of our time. On the other hand, resilience, i.e. maintaining or regaining mental health despite stressors, is a frequent phenomenon. Since several years, resilience research is undergoing a period of transition. Based on a new understanding of resilience as dynamic process, new approaches were proposed. This symposium will present current results and conceptual developments of neurobiological resilience research. Introducing the symposium, Prof. Tüscher presents the frequent stressor and mental health monitoring (FRESHMO)-paradigm. First behavioral and fMRI results from the Longitudinal Resilience Assessment Study (LORA) & Mainz Resilience Project (MARP) resilience studies exemplifying FRESHMO operationalization and measurement of resilience for the identification of resilience processes in longitudinal studies will be shown. The potential of high-frequency monitoring will be further illustrated by the example of even higher frequency sampling in case of the Corona crisis as an ubiquitous stressor by M.Sc. Ahrens. This approach has led to the identification of different respondent groups and resilient factors in the context of a major natural and societal stressor. The question which genetic factors can predict resilience will be addressed by Prof. Plichta. Analyses of polygenic risk and resilience scores as neurobiological resilience predictors are derived from the LORA study and will be discussed in terms of their ability to explain significant variance in resilience in comparison to self-reported resilience factors. The symposium is concluded by presentation of neuropsychological predictors of resilience by Dr. Kollmann. Emotional interference control is a postulated cognitive mechanism of positive appraisal as a major resilience mechanism. The talk discusses the importance of the mechanism and clinical implications of the results for the prevention of stress-related disorders.
The frequent stressor and mental health monitoring for identification of resilience processes in longitudinal studies – first results from LORA & MARP
Oliver Tüscher, Mainz (Germany)
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Oliver Tüscher, Mainz (Germany)
Resilience has been defined as the maintenance or quick recovery of mental health
during and after times of adversity. One of the biggest challenges for implementing an
outcome-based definition of resilience in longitudinal observational study designs lies in
the fact that real-life adversity is usually unpredictable and that its substantial qualitative
as well as temporal variability between subjects often precludes defining circumscribed
time windows of inter-individually comparable stressor exposure relative to which the
maintenance or recovery of mental health can be determined. We propose to frequently and regularly monitor stressor exposure (E) and mental health problems (P) throughout a study’s observation period [Frequent Stressor and Mental Health Monitoring (FRESHMO)-paradigm]. On this basis, a subject’s deviation at any single monitoring time point from the study sample’s normative E–P relationship
(the regression residual) can be used to calculate that subject’s current mental health
reactivity to stressor exposure (SR). The SR score takes into account
the individual extent of experienced adversity and is comparable between and within
subjects. Individual SR time courses across monitoring time points reflect intra-individual
temporal variability in SR, where periods of under-reactivity (negative SR score) are
associated with accumulation of fewer mental health problems than is normal for the
sample. If FRESHMO is accompanied by regular measurement of potential resilience
factors, temporal changes in resilience factors can be used to predict SR time courses.
An increase in a resilience factor measurement explaining a lagged decrease in SR
can then be considered to index a process of adaptation to stressor exposure that
promotes a resilient outcome (an allostatic resilience process). Hence, FRESHMO plus regular resilience factor monitoring incorporates a dynamic-systems perspective into resilience research.
From Kalisch et al. Front Psychol. 2021
Resilience against mental distress in the COVID pandemic
Kira F. Ahrens, Frankfurt Am Main (Germany)
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Kira F. Ahrens, Frankfurt Am Main (Germany)
The COVID-19 pandemic and resulting measures can be regarded as a global stressor. Cross-sectional studies showed rather negative impacts on people's mental health, while longitudinal studies considering pre-lockdown data are scarce. In chronic stress research we face the obstacles that stress does not have a well-defined starting point and it may occur at different time points for individuals. The COVID-19 pandemic provided a rare opportunity to study the impact of an adverse event simultaneously on a sample that was well characterized in advance. The present study investigated the impact of lockdown measures in a longitudinal German sample, assessed since 2017. Starting at the end of March 2020, 523 participants completed additional weekly online questionnaires on e.g., mental health, COVID-19-related and general stressor exposure. Predictors for and distinct trajectories of mental health outcomes were determined, using multilevel models and latent growth mixture models, respectively. Social support, positive pandemic appraisal, and adaptive cognitive emotion regulation were positively, whereas perceived stress, daily hassles, and feeling lonely negatively related to mental health outcomes in the entire sample. Three classes ("recovered," 9.0%; "resilient," 82.6%; "delayed dysfunction," 8.4%) with different mental health responses to initial lockdown measures were identified. Classes differed in perceived stress and COVID-19-specific positive appraisal. Although most participants remained mentally healthy, as observed in the resilient class, we also observed inter-individual differences during the first 8 weeks of lockdown in Germany. Participants' psychological state deteriorated over time in the delayed dysfunction class, putting them at risk for mental disorder development. In addition, first results on the long term effects of 1.5 years of lockdown in Germany are presented. Practical implications of the study on health services are discussed.
Polygenic risk scores and hair cortisol predict mental health during COVID lockdown
Michael Plichta, Frankfurt Am Main (Germany)
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Michael Plichta, Frankfurt Am Main (Germany)
COVID-19 pandemic and the resulting lockdowns can be regarded as a global stressor and mental health responses may vary inter-individually. Consistently observed mental health trajectories in response to potentially traumatic events are resilience, recovery, chronic and delayed onset. Polygenic Risk Scores indicate individual propensities to specific phenotypes and have been related to negative mental health outcomes. Long-term elevated cortisol levels, frequently measured by hair cortisol concentration (HCC), have been shown to be related to stress-related mental disorders. Therefore, we analyze whether PRS and HCC are related to differential trajectories of mental health during lockdown.
A subsample of 523 participants from the longitudinal resilience assessment study (LORA) completed weekly online questionnaires on mental health (GHQ-28), COVID-19-related, and general stressor exposure during COVID-Lockdown. Blood was collected at the baseline of the original LORA study and was used to calculate Polygenic Risk Scores (PRS). Hair samples were collected quarterly for determining long-term Glucocorticoid hair cortisol concentration. Multivariate Logistic Regression is performed to analyze the associations of HCC and PRS with the observed trajectories.
Preliminary results indicate a significant association between elevated Glucocorticoid hair cortisol concentration and the membership to an "at-risk" trajectory. Participants can be well assigned to different mental health trajectories by combining the information of different PRS and long-term cortisol concentration.
Long-term Glucocorticoid hair cortisol concentration seems to be a significant predictor for the mental health response to a global stressor, hence the COVID-lockdown. Furthermore, PRS give additional information for reliable classification of participants to different mental health responses.
Neurocognitive domains of resilience – emotional interference control
Bianca Kollmann, Mainz (Germany)
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Bianca Kollmann, Mainz (Germany)
Several potential cognitive mechanisms have been proposed to foster resilience. Their effect on resilience is supposed to be influenced by a person’s appraisal style according to the positive appraisal style theory of resilience (PASTOR). It claims that a person with a tendency to positively/non-negatively appraise potentially threatening stimuli, is less likely to experience stress in these situations. Over time, this should result in less chronic or severe acute stress, enabling the maintenance of mental health. One of these cognitive mechanisms is emotional interference inhibition (EII). It allows for the continuation of goal-directed behavior despite adversity elicited through stress. It is a prerequisite for positive appraisal, because it suppresses irrelevant thoughts and memories (i.e. cognitive inhibition), enabling the initiation of an appraisal process. Moreover, it inhibits negative emotions elicited by an adverse stimulus (i.e. emotional inhibition), allowing the re-appraisement of these emotions (Kalisch et al., 2015). In the LOngitudinal Resilience Assessment (LORA) study, EII is measured with an emotional Flanker task, in which a picture of either negative or neutral emotional valence precedes the presentation of the target stimulus. Linear mixed models in N = 1139 participants revealed that participants’ positive appraisal style (PAS) scores predicted EII performance at baseline. More precisely, participants with higher self-reported PAS were better at solving trials with increasing cognitive demand (t = -2.90, p < .01), indicating good cognitive inhibition abilities. Further, better EII ability at baseline predicted lower stressor reactivity scores 1.5 years later (t = -2.34, p < .05), indicating higher resilience. Thus, EII likely supports homeostatic adaptation of the organism to preserve resilience over time. In sum, first evidence supports the notion that EII promotes resilience over time and that there is an influence of PAS on EII ability.