Modelling resilience in adolescence and adversity: a novel framework to inform research and practice

Abstract

Recent conceptualisations of resilience have advanced the notion that it is a dynamic and multifaceted construct. However, its adaptive components, especially those forged by adversity, have not been fully realised, and its neurobiological and psychosocial underpinnings are yet to be meaningfully integrated. In part, this is because a developmental perspective is often neglected in the formulation of resilience. In this review, we consider the findings of resilience research, with a specific emphasis on the developmental period of adolescence. To bridge the gaps in our current understanding, we propose a model of resilience that is predicated on experiencing adversity. Specifically, our model provides a sophisticated insight into the components of resilience, which, together with intrinsic features, involves facilitation of, and skill acquisition via strengthening processes we term tempering and fortification. The model also points to the potential trajectories of adversity-driven resilience and forms the basis of a framework that allows for individual variance in resilience, and the identification of both neurobiological and psychosocial targets for prevention and therapeutic interventions.

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

“…Coping explains moderate amounts of variance in cross-sectional and prospective depression risk, playing multiple roles in developmental cascades towards mood disorder (Zimmer-Gembeck and Skinner, 2016). Successful coping with adversity can also decrease risk for mood disorder and resilience is a protective factor with adaptive components that are developed primarily in the context of adversity (Malhi et al, 2019b). As highlighted in MDcpg 2015 , the development of resilience is a key target of all treatments for mood disorders.…”

“…Consistent with these more holistic views of mental health, resilience refers to the ability to adapt to, and recover from, stress; not simply the absence of vulnerability (Malhi et al, 2019b). There is evidence that resilience plays a mitigating role across all stages in the management of mood disorders (see MDcpg 2015 , and consideration of coping responses above).…”

“…In other words, acute exacerbations of the disorder (major depressive episodes) can be resolved using currently available treatments but as yet, it is not possible to cure the illness altogether. Nevertheless, resilience against depression can be enhanced, and many of the recommended Actions as part of laying down a foundation for the management of depression, likely contribute to the development of resilience through adaptive processes such as tempering and fortification (Malhi et al, 2019b). Therefore, the value of the initial Actions should not be underestimated and these should be implemented as comprehensively as possible.…”

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary

“…Resilience in the management of depression has been formulated as an adaptive process that can defend against depression through strengthening processes such as tempering and fortification. 26 In patients where pharmacotherapy is deemed necessary from the outset, because of patient preference or symptom severity, it is important to ensure that the necessary Actions have been undertaken. This is because it has been shown that the implementation of psychological therapies alongside pharmacotherapy enhances outcomes, and because adverse social and lifestyle factors often maintain depression.…”

“…Resilience in the management of depression has been formulated as an adaptive process that can defend against depression through strengthening processes such as tempering and fortification 26 . This presents an opportunity for building resilience, initially through psychological interventions.…”