Annual Research Review: Resilience - clinical implications: Resilience: clinical implications

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Abstract

It is a universal finding that there is huge heterogeneity in people's responses to all kinds of stress and adversity. Resilience is an interactive phenomenon that is inferred from findings indicating that some individuals have a relatively good outcome despite having experienced serious adversities. Resilience can only be inferred if there has been testing of environmental mediation of risks and quantification of the degree of risk. The use of 'natural experiments' to test environmental mediation is briefly discussed. The literature is then reviewed on features associated with resilience in terms of (a) those that are neutral or risky in the absence of the risk experience (such as adoption); (b) brief exposure to risks and inoculation effects; (c) mental features (such as planning, self-regulation or a sense of personal agency); (d) features that foster those mental features; (e) turning point effects; (f) gene-environment interactions; (g) social relationships and promotive effects; and (h) the biology of resilience. Clinical implications are considered with respect to (a) conceptual implications; (b) prevention; and (c) treatment. Resilience findings do not translate into a clear programme of prevention and treatment, but they do provide numerous leads that focus on the dynamic view of what may be involved in overcoming seriously adverse experiences. © 2012 The Author. Journal of Child Psychology and Psychiatry © 2012 Association for Child and Adolescent Mental Health.

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Developmental plasticity and human health.

Patrick Bateson, David Barker, Timothy Clutton-Brock … (2004)

Many plants and animals are capable of developing in a variety of ways, forming characteristics that are well adapted to the environments in which they are likely to live. In adverse circumstances, for example, small size and slow metabolism can facilitate survival, whereas larger size and more rapid metabolism have advantages for reproductive success when resources are more abundant. Often these characteristics are induced in early life or are even set by cues to which their parents or grandparents were exposed. Individuals developmentally adapted to one environment may, however, be at risk when exposed to another when they are older. The biological evidence may be relevant to the understanding of human development and susceptibility to disease. As the nutritional state of many human mothers has improved around the world, the characteristics of their offspring--such as body size and metabolism--have also changed. Responsiveness to their mothers' condition before birth may generally prepare individuals so that they are best suited to the environment forecast by cues available in early life. Paradoxically, however, rapid improvements in nutrition and other environmental conditions may have damaging effects on the health of those people whose parents and grandparents lived in impoverished conditions. A fuller understanding of patterns of human plasticity in response to early nutrition and other environmental factors will have implications for the administration of public health.

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Serotonin transporter genetic variation and the response of the human amygdala.

Ahmad R Hariri, Venkata S. Mattay, Alessandro Tessitore … (2002)

A functional polymorphism in the promoter region of the human serotonin transporter gene (SLC6A4) has been associated with several dimensions of neuroticism and psychopathology, especially anxiety traits, but the predictive value of this genotype against these complex behaviors has been inconsistent. Serotonin [5- hydroxytryptamine, (5-HT)] function influences normal fear as well as pathological anxiety, behaviors critically dependent on the amygdala in animal models and in clinical studies. We now report that individuals with one or two copies of the short allele of the serotonin transporter (5-HTT) promoter polymorphism, which has been associated with reduced 5-HTT expression and function and increased fear and anxiety-related behaviors, exhibit greater amygdala neuronal activity, as assessed by BOLD functional magnetic resonance imaging, in response to fearful stimuli compared with individuals homozygous for the long allele. These results demonstrate genetically driven variation in the response of brain regions underlying human emotional behavior and suggest that differential excitability of the amygdala to emotional stimuli may contribute to the increased fear and anxiety typically associated with the short SLC6A4 allele.

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Epigenetics and the biological definition of gene x environment interactions.

Michael Meaney (2010)

Variations in phenotype reflect the influence of environmental conditions during development on cellular functions, including that of the genome. The recent integration of epigenetics into developmental psychobiology illustrates the processes by which environmental conditions in early life structurally alter DNA, providing a physical basis for the influence of the perinatal environmental signals on phenotype over the life of the individual. This review focuses on the enduring effects of naturally occurring variations in maternal care on gene expression and phenotype to provide an example of environmentally driven plasticity at the level of the DNA, revealing the interdependence of gene and environmental in the regulation of phenotype.