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Study of Vets Suggests Basis of Stress Hardiness


 

NEW YORK — Severe stress can have lasting effects, most dramatically in posttraumatic stress disorder. But many people undergo equally traumatic experiences—combat, natural disasters, imprisonment, torture—and emerge relatively intact.

What protects them?

Dr. Steven Southwick, a psychiatrist at Yale University, New Haven, Conn., has studied groups of combat veterans, former prisoners of war, and others who have done well after highly stressful experiences, using in-depth interviews and brain imaging to identify factors that may explain such resilience.

“Metaphorically, they resemble a twig with a green, growing core. When twisted out of shape, [the twig] springs back and continues to grow,” he said, citing Dr. George Vaillant, a professor of psychiatry at Harvard Medical School, Boston.

One biologic factor that distinguished this group involved neuropeptide Y, which is released along with norepinephrine under stressful conditions and has the effect of dampening arousal. “Neuropeptide Y turns the nervous system down,” Dr. Southwick said at a meeting on psychopharmacology sponsored by New York University. He noted that people with PTSD tend to have low levels of the chemical.

A group of U.S. Army Special Forces veterans who had done well under highly stressful combat conditions was found to have unusually high serum concentrations of neuropeptide Y. “This could enable them to remain cool under pressure,” he said.

A wider spectrum of personal and relationship traits emerged as being characteristic of resilient people. For example, a supportive social network—“having others around you”—may bolster the ability to contain one's own neurobiologic responses, Dr. Southwick said.

Mentors and powerful role models seemed to make a particular difference: “Everyone talked about them,” he said. The influence of a mentor appears to be a complex issue that can be understood from social, psychological, and biologic perspectives, and may involve the capacity for self-soothing under duress.

“Moral compass and integrity,” a factor mentioned by many interviewees, may offer protection against the guilt that appears to play a “huge” role in PTSD. One interviewee described his sense of right and wrong as “something to keep me afloat when drowning.”

The ability to find meaning and purpose even in very harsh circumstances—to “stand for an idea”—was a similar source of strength.

Interviewees “without exception” cited optimism and fighting spirit. “This wasn't 'rose-colored glasses,” but optimism born of adversity,” that neither ignored the negative nor dwelled on it, he said.

Optimism's complement was acceptance. Dr. Southwick noted that “every resilient person seemed to understand the necessity of knowing when to accept a situation as something that couldn't be changed.” Cognitive reappraisal was a related factor. “Really resilient people were very good at … focusing on what's left, not what's lost, and finding opportunity in adversity,” he said.

With regard to behavior, resilient people had an active—not passive—coping style that involved an approach to, rather than a withdrawal from, challenging situations. This style accords with neurobiologic studies showing that activity reduces amygdala arousal associated with fear.

Using signature strengths and skills seemed to be especially important. Engaging in activities that one does well was commonly described as invigorating: “One man, a firefighter, compared 'fighting a good fire' to pitching a no-hitter. In a desk job, he was no longer resilient; he wasn't using his skills and strengths,” Dr. Southwick said.

“There was no substitute for training,” he added.

The ability to face one's fears was crucial. “Most of us avoid fear—it's too painful—and find a way to reduce it. Avoidance helps in the short run but not the long run,” he said.

The Special Forces veterans interviewed said they had learned the skills necessary to move through fear, to confront it, and to develop plans to deal with its source. Dr. Southwick said his research with resilient people had changed his clinical approach as a psychiatrist: “I spend a lot more time working with people's strengths and finding out what they believe in.”

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