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Resiliency and coping 

Resiliency and coping
Chapter:
Resiliency and coping
Author(s):

Gregory Fricchione

and Shamim Nejad

DOI:
10.1093/med/9780199571390.003.0050
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date: 15 December 2017

Resilience to stress is multi-determined. In the face of extreme stress or trauma, an individual may develop psychopathology with significant functional decline or may recover quickly, with minimal psychological sequelae. When response emerges depends upon an interconnected and dynamic mix of factors, including the individual’s neurobiological and psychological profile, personal trauma history, and peri-traumatic circumstances, such as availability of social support networks. The growing body of knowledge regarding the many factors that affect an individual’s response to stress will likely lead to the development of new therapies, both pharmacological and psychotherapeutic, for enhancing resilience to stress. Stress inoculation training, via exposure to manageable stressors, may be useful in building resistance to adversity in both children and adults. It may also be possible to enhance resilience with pharmacological means. The likelihood and/or severity of stress-induced psychopathology in the future may be reduced with the use of NPY, DHEA, CRH-1 antagonists, and GAL-1 agonists. Further research will be necessary to investigate the potential of these and other molecules and compounds to dampen the stress response in humans. In addition, it will be necessary to evaluate the efficacy of agents that target receptors involved in fear conditioning and fear extinction, that is, voltage-gated calcium channels, beta adrenergic receptors, tyrosine kinase b receptors, and NMDA receptors. By weakening fear-conditioning mechanisms and enhancing fearextinction pathways, it may be possible to attenuate the progress and encoding of traumatic memories that often occurs upon exposure to trauma. All of the potential new pharmacotherapies for preventing and/or treating stress related disorders can be coupled with psychotherapy. Cognitive behavioural therapies can assist patients in learning how to reframe adverse events and cognitive distortions, how to adopt active coping techniques when faced with problems, and how to achieve greater cortical control over negative emotions. Prolonged exposure therapy is particularly useful in helping patients to extinguish learned fear associations. Individual and group mind body approaches designed to enhance the core components of human resiliency as discussed above can have benefits for primary, secondary, and tertiary prevention. Continued progress in understanding the genetic, developmental, biological, and psychological underpinnings of resilience and vulnerability to stress, as well as the interactions between these factors, will aid in moving the field toward the identification, prevention and treatment of those at risk of developing stress-related psychopathology.

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