Barcelona snapshots

Prof. Dan J. Stein

Dan J. Stein psychiatrist South Africa Controversias Psiquiatry Barcelona
University of Cape Town, South Africa
Talk Resilience: An Integrative Approach
Date Friday, April 20th, 2018
Time 11:45 to 12:30
Table Etiological complexities

BIOGRAPHY

Dan J. Stein is Professor and Chair of the Dept of Psychiatry and Mental Health at the University of Cape Town and Director of the South African Medical Research Council's Unit on Risk & Resilience in Mental Disorders. His work has long focused on anxiety and related disorders, including obsessive-compulsive spectrum conditions and posttraumatic stress disorder. His research had led to a broad range of publications, spanning from basic neuroscience, through clinical research, and on to public mental health. He is enthusiastic about clinical practice and scientific research that integrates concepts and data across these different levels, including in the context of low and middle-income countries. He has a strong track record of leadership in psychiatric organizations, and of mentorship of students and faculty. He is a recipient of the Collegium Internationale Neuropsychopharmacologicum's Max Hamilton Award for his contributions to psychopharmacology, and of its Ethics in Psychopharmacology Award.

ABSTRACT

Several decades of research on stressors and stress responses have paved the way for advances in our understanding, not only of trauma- and stressor-related disorders, but also of resilience. It is noteworthy that exposure to trauma is extremely common, acute stress and adjustment disorders are also highly prevalent, but posttraumatic stress disorder (PTSD) occurs only occasionally. The fact that individuals return to health so commonly after exposure to stress and trauma, emphasizes resistance to environmental risk experiences, or the overcoming of adversity; but the degree of resilience may vary over time and according to circumstance.

The precise neurobiology of stress responses and posttraumatic stress disorder has been increasingly delineated by both neuroimaging and neurogenetic studies, although much remains to be understood. International collaborations on brain imaging (e.g. Enhancing Neuroimaging-Genetics Meta-Analysis, or ENIGMA) and on genetics (e.g. the Psychiatric Genetics Consortium, or PGC) have played a particularly important role in advancing current knowledge. It is also relevant to consider stress responses and resilience from an evolutionary perspective which emphasizes the potential value of different life history strategies.

Research on various processes involved in stress and threat responses, including fear conditioning and social buffering of stress may be relevant to understanding the specific mechanisms that underlie resilience. On the one hand early adversity is a well-known risk factor for psychopathology; on the other hand, it is likely that some degree of exposure to adversity is needed in order to build hardiness. More detailed longitudinal studies of resilience during development are needed to fully understand these different pathways. The psychobiology of intergenerational transmission of trauma and of resilience is increasingly being studied.

From a clinical perspective, it is relevant to assess patients' strengths, including adaptive responses to trauma, and to complement a focus on interventions to decrease trauma-related symptoms with a consideration of those which may act to enhance resilience. Several cognitive-behavioral techniques may promote resilience, including increasing optimism, enhancing cognitive flexibility, and developing active coping skills. It is also relevant to consider whether pharmacotherapeutic interventions may have resilience-enhancing properties.

REFERENCES

Del Giudice M, Ellis BJ (2016). Evolutionary foundations of developmental psychopathology, in Cicchetti D (ed), Developmental psychopathology. New York, Wiley & sons, 2016.

[web] Kalisch R, Muller MB, Tuscher O (2015). A conceptual framework for the neurobiological study of resilience, Behav Brain Sci. 2015;38:e92. doi: 10.1017/S0140525X1400082X. Epub 2014 Aug 27.

[PDF] Karatsoreos IN, McEwen BS (2013). The neurobiology and physiology of resilience and adaptation across the life course, J Child Psychol Psychiatry. 2013 Apr;54(4):337-47. doi: 10.1111/jcpp.12054.

[web] Klika JB, Herrenkohl TI (2013). A review of developmental research on resilience in maltreated children, Trauma Violence Abuse. 2013 Jul; 14(3): 222–234. Published online 2013 May 10. doi: 10.1177/1524838013487808

[web] Stein DJ (2009). The psychobiology of resilience, CNS Spectr. 2009 Feb;14(2 Suppl 3):41-7.