A resilience framework for promoting stable remission from depression

Abstract

A significant proportion of people in remission from depression will experience a recurrence of depression. One theoretical mechanism for this recurrence is that with each additional episode of depression, people become more sensitive to the deleterious effects of less powerful stressors. We propose that research on resilience -the ability to adapt to and recover from stress -can inform interventions to prevent recurrence in people in remission. We conceptualize resilience as a dynamic process that may be deficient in people in remission from depression, rather than as a static personal quality that is unattainable to people who have experienced psychopathology. The three aspects of resilience that we suggest are the most important to target to prevent recurrence are (1) improving stress recovery from minor daily stressors that may aid remitted people in coping with major stressors, (2) increasing positivity, like promoting positive emotions during stress, (3) and training flexibility -the ability to identify different demands in the environment and employ the appropriate coping strategy to meet those demands. We offer suggestions for the appropriate assessment of changes in resilience in remitted people and provide some examples of effective resilience interventions.

The interplay between cognitive risk and resilience factors in remitted depression: A network analysis

“…This indicates the importance of directly targeting resilience next to focusing on specific vulnerabilities. At the clinical level, it is interesting to note that the central role of resilience also parallels an increased interest in treatments that focus on resilience (Garland et al, 2010;Geschwind et al, 2011;Keng et al, 2011;Waugh and Koster, 2015). Indeed, our findings indicate that patients may benefit from interventions targeting resilience mechanisms.…”

“…For instance, previous studies have shown that depression is associated with impaired stress-and emotional reactivity (Burke et al, 2005;Bylsma et al, 2008), which may continue during remission (e.g., O'Hara et al, 2014). In line with these findings, Waugh and Koster (2015) argue that stress recovery, positivity or promotion, and flexible application of coping responses -among other intra-or interpersonal factors contributing to resilience -may play an important role in preventing recurrence of depressive symptoms (but also see Southwick et al, 2005). These factors match the operationalization of resilience in this study, in line with Wagnild (2009), referring to concepts such as optimism, effectively coping with adversity, and flexibility.…”

“…The stability of these findings was confirmed using additional operationalizations for some of the key constructs (e.g., 'brooding' as indicator of maladaptive emotion regulation, 'positive appraisal' as indicator of adaptive emotion regulation, and an alternative measure for 'depressive symptomatology'; available upon request). Provided a dynamic conceptualization of resilience as a protective factor that may be insufficiently represented in remitted depressed patients (Waugh and Koster, 2015), these findings suggest that manipulating resilience may be an efficient way to increase other protective factors (e.g., adaptive emotion regulation), as well as decrease risk factors for recurrent depression (e.g., cognitive dysfunctioning, maladaptive emotion regulation, and residual symptomatology). This is in line with recent views on the importance of resilience in stable remission from depression (Garland et al, 2010;Waugh and Koster, 2015).…”

“…Provided a dynamic conceptualization of resilience as a protective factor that may be insufficiently represented in remitted depressed patients (Waugh and Koster, 2015), these findings suggest that manipulating resilience may be an efficient way to increase other protective factors (e.g., adaptive emotion regulation), as well as decrease risk factors for recurrent depression (e.g., cognitive dysfunctioning, maladaptive emotion regulation, and residual symptomatology). This is in line with recent views on the importance of resilience in stable remission from depression (Garland et al, 2010;Waugh and Koster, 2015). Importantly, these findings are not fully in line with the hypothesis that emotion regulation strategies would be important predictors of resilience.…”

“…Indeed, our findings indicate that patients may benefit from interventions targeting resilience mechanisms. Among more common cognitive behavioral interventions (e.g., Songprakun and McCann, 2012;Steinhardt and Dolbier, 2008), Waugh and Koster (2015) argue that patients may benefit from well-being training, stress inoculation training, meditation and mindfulness-based cognitive therapy (for a meta-analytical review on the efficacy of resilience training programs, see Leppin et al, 2014).…”