Q&A with Psychiatrists on How to Bounce Back After Severe Stress

Post-traumatic stress disorder (PTSD) experts Dr. Steven Southwick and Dr. Dennis Charney investigate the power of resilience in their new book, Resilience: The Science of Mastering Life's Greatest Challenges.

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Justin Lane / EPA

Kulib Abbas sits in a chair near the remains of his home as people in the area continue to deal with the aftermath of Hurricane Sandy in the Oakwood Beach neighborhood of Staten Island, New York, Nov. 12, 2012.

Post-traumatic stress disorder (PTSD) experts Dr. Steven Southwick and Dr. Dennis Charney investigate the power of resilience in their new book, Resilience: The Science of Mastering Life’s Greatest Challenges.

Recovering from a natural disaster takes physical and psychological strength, and as those attempting to rebuild their lives in the aftermath of Hurricane Sandy are learning, it doesn’t hurt to have help. To better understand which tools help us to bounce back from trauma and cope with stress, Southwick, a psychiatry professor at Yale University, and Charney, a psychiatry professor at Mount Sinai Hospital, studied Navy SEALs, rape survivors, prisoners of war and others who overcame highly stressful situations with only minimal mental hardship. It turns out that these survivors share critical skills that can support anyone, even those who haven’t been professionally trained or naturally endowed with resilience, to better combat trauma.

Why did you decide to study resilience?
Dennis Charney: We were studying the biology and the psychology of PTSD and depression,  so we were working with those patients.  About 15 or so years ago, we started to think, ‘There are some people who seem to be stress-resistant. Maybe we can learn from them what enables those people to get through tough times, so that might bear on understanding vulnerability.’

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Who did you include in your research?
DC: We ended up studying prisoners of war (POWs) from Vietnam. They were held for six to eight years in the Hanoi Hilton, as they nicknamed it.  That was an amazing experience to interview these men and we learned a lot from the POWs. The reason we chose [these men] is that they did well when they got out. We wanted to understand how they did well.

Steven Southwick: We [also] decided to interview special forces instructors. Who better to teach us how to deal with fear and stress?  We kept seeing the same themes over and over. [We said], ‘Well this is great, but let’s see what science there is to back these recommendations and observations.’ We went to the psychological literature and it turns out there’s a lot of support for these particular factors and quite a bit of neurobiological support as well.

DC: We studied U.S. Special Forces including Navy SEALs and Green Berets. We also studied a population of men and women from inner city Washington, DC who lived in poverty and grew up surrounded by stress, [as well as] a group of earthquake victims in remote Pakistan. They had a earthquake that killed 250,000 people. We got to know and study  individual women who were victims of sexual and physical abuse.

We found things in common from these disparate groups, a common set of factors that seemed to relate to resilience.  We ended up boiling them down to 10 factors. You can train yourself to be more resilient by paying attention to these. And you don’t need all 10.  Some are more pertinent to one individual than they are to another to help you get through tough times.

Tell me about some of them…
DC: The first one is a positive attitude, optimism. It’s important to note that it’s realistic optimism we’re talking about. You need to have a very clear eyed view of the challenges you’re facing. You can’t gloss it over: ‘This is a challenge, but I will prevail.’

You may have unrealistic optimism and in combat that can get you killed. It’s a recipe for failure if you don’t evaluate your challenges accurately. [This] can be learned and that does relate to therapy.  Cognitive behavioral therapy helps you become more realistically optimistic  and not inappropriately pessimistic.

Another surprising factor involves being true to your own morals…
DC: It’s to embrace a personal moral compass,  develop a set of beliefs that very few things can shatter. That’s really important. It was very important to the POWs. They were being tortured, but their own set of beliefs about what was right [could] not be touched

SS:  I don’t think I was expecting that to be as powerful as it was. [But] one of the things often happens in highly stressful situations, particularly if someone else is injured or killed is that there’s a tremendous tendency to develop survivor guilt.

We’ve interviewed some medal-of-honor winners.  They are the bravest of the brave. There are only some 200 of them in the U.S.  No one could do more.  But the few we interviewed in depth, they have survivor guilt. They felt that they should have done more. [So] that’s going to happen no matter what you do and you don’t want to add to that if you violate some principle you think is important.

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What role do religion and spiritual beliefs play in resilience?
DC: That comes under a moral compass. Some develop strong beliefs independent of religion and others find it very helpful. It’s not important for everybody but for some people, it’s very important. When we studied [those in poverty] in  DC, who were largely African American, religion was very important. Going to services was very useful for establishing social networks,  in addition to the core beliefs. It adds to the other elements.  Some of the POWs found religion to be very important,  but not every one of them.

But social support, on the other hand, does seem to be necessary…
DC: [Yes]. One of the other factors is that you establish and nurture a supportive social network:  very few can go it alone. You need a safety net during times of stress. The [POWs] helped each other. They developed a code to tap through the walls [to communicate]. Many said that there’s no way they could have gotten through it unless they could communicate and get support.

SS: It looks like social isolation has as powerful an effect on longevity as smoking and [heavy drinking] and lack of exercise. It’s very bad for you. There’s lots of neat connections between social connectedness and ability to handle stress.

Social connection is also part of helping other people, which is another factor that matters…
DC: Altruism. Jerry White [who was injured by a landmine as a young man and ultimately won the Nobel Peace Prize with Princess Diana] converted the tragedy of losing his leg to form a network that [is aimed at] ridding the world of landmines. Mothers Against Drunk Driving: that comes out of tragedy, but it enables personal growth and self esteem.

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Even with all these factors, however, how much of resilience is genetic?
DC: It’s hard to put a percentage on it, but there is a component that is genetic. Some genes seem to be related to being protective. Genes play a role, but they are not destiny.

SS: Genes are important but not nearly as important as you might imagine.

What about early childhood experience?
SS:  Thousands of studies show that uncontrollable stress tends to be toxic to the nervous system. [However] there are [also] lots of animal studies where infants that are exposed to manageable stress actually develop stress responses that are hardier than some that are not exposed to stress at all.

So, is it good to stress your child? Yes, as long as it’s manageable. This is why it’s difficult to be a really good parent or coach. It takes great skill. I don’t want this person to be overwhelmed by stress in a way that they cannot manage. It’s a difficult skill to understand [a child] well enough so you know what’s out of [their] comfort zone but is not unmanageable.

DC: My kids said to me that when I started studying resilience, I got tougher on them and they’re right. You’ve got to challenge kids— not abuse or overly stress them, but show them that they can accomplish things that they thought were not possible. If you make it too easy, they’re not prepared when stuff happens.

And that connects to another resilience skill, which is to welcome challenges and not fear negative consequences that may result from traumatic experiences…
DC: You don’t want fear to alter your life or constrict your life. Fear is normal.  When we got to know the special forces, who do things that are incredibly dangerous, they say, ‘We’re afraid, of course.’ If you don’t feel fear, you cannot understand what you are facing. Fear is normal and can be used as a guide.

One guy in the book got into plane crash when he was parachuting. He said to himself, ‘If you don’t get right back into that plane, you’re never gonna fly again.’ He got in that same day. [He hadn’t been injured in the crash].

Not everyone can do that, however…
DC: When you are moving through the fear, you don’t do it all of a sudden. There’s a term called stress inoculation.   That’s inherent in facing fears. If you do one thing at a time and master it and go to the next step, [then] you’ve got a psychological tool box that enables you to handle things you were just too afraid to do.

You’re also studying the chemistry of all this, including something called neuropeptide Y (NPY).  What is that?
DC: It’s a peptide that lots of laboratory animals studies show [can] reduce anxiety and fear.  We found with the special forces that the higher [levels] went up in their blood, the better they were able to perform under stress. There’s also genetic data suggesting that with a more robust NPY system, you can handle stress better. We’re testing it now [as a treatment for patients with PTSD].  It’s too early to know.  We’re six months away from results.

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What can parents do to help their children become resilient?
SS: [As a parent] you are affecting and molding the way your child’s stress hormones and nervous system will respond in the future. It’s very plastic and you are, by the type of stress you’re exposing them to and the way you respond, [helping shape] the degree to which they will master it or not. This  affects how the stress response will work in adulthood.

The problem is either neglect or over-parenting. You want to be the helicopter swooping down and fixing it, but then the child doesn’t learn how to meet these challenges. You have to really know where is ‘out of the comfort zone’ and where they flip into an inability to [cope] and become overwhelmed. And people are so different and so unique. I love the term ‘Good-enough Mother’ from the [child psychiatrist] D.W. Winnicott. You just need to be good enough.