What does it take to increase our resilience?

Whether striving for personal growth or seeking ways to overcome difficult challenges and adversities, resilience has become an ideological goal pursued by many. There is an abundance of research on what defines resilience (e.g., bouncing back from adversity to positive indicators of functioning; Southwick et al., 2014), the indicators of resilience (e.g., traits, characteristics, and resources; Luthar et al., 2000), and strategies to increase resilience (e.g., psychoeducation, physical activity, mindfulness-based). However, there is a paucity of research synthesis that enables us to draw distinct conclusions. Paralleling these concerns are the growing interests and needs for resilience during the current cultural climate marked by a global pandemic that has amplified existing social, racial, and economic inequities in various communities. In an effort to construct meaning from the vast bodies of research focusing on resilience interventions, a recent meta-analysis produced a comprehensive review of the literature in order to substantiate their effectiveness (Liu et al., 2020). Using data extracted from 268 studies with a total of 1584 samples, Liu et al. (2020) summarized whether resilience interventions were effective, for whom, using what approaches, and across what types of outcomes.

Are resilience interventions effective?

Collectively, resilience interventions amounted to a small but practically significant effect, relative to the effect sizes observed in social sciences, g = 0.48, SE = 0.04, CI (0.40, 0.56) (Ferguson, 2009; Liu et al., 2020). The direction and magnitude of resilience intervention effects are comparable to those of other clinical interventions, including pharmacotherapy for depression (g = 0.49; Watts et al., 2015), and mindfulness-based stress reduction (g = 0.53; Khoury et al., 2015). Compared to positive psychological interventions (d = 0.204 – 0.34; Bolier et al., 2013; White et al., 2019), resilience interventions appear more efficacious, though the effects observed are still modest compared to the standards established by cognitive behavioural therapy for depression (g = 0.70 – 0.71; Cuijpers et al., 2013; Watts et al., 2015).

Similar to meta-analyses conducted with other interventions, the effects were largely variable, with diversities observed across types of outcomes measured, intervention approaches employed, and targeted population characteristics. In capturing intervention effects, a number of categories of outcomes are used as indicators of resilience, including action-based outcomes (e.g., changes in behaviour, such as alcohol consumption), biophysiological indexes (e.g., changes in body mass index or cortisol), coping (e.g., changes in problem solving), emotion (e.g., affective states), resilience (e.g., self-reports of resilience resources), symptoms (e.g., reductions in anxiety or depression), and well-being (e.g., changes in quality of life or self-compassion). Based on findings, action-based, resilience, symptom, and well-being outcomes emerged as meeting the threshold for effect size of practical significance, while biophysiological outcomes appear to be the least robust indicators of intervention effects. 

For whom are resilience interventions the most effective?

Resilience interventions with adult populations and populations experiencing moderate to high levels of risk exposures were found to be the most effective. This is likely due to a combination of ceiling effects that may be observed in samples without prior trauma or ongoing stressors, as well as the ease of intervention implementation and adherence to intervention protocols compared to other population groups. In addition, the alignment between intervention approaches to foster resilience, and the outcomes used as indicators of resilience share an important relationship. For example, interventions using evidence-based approaches to promote resilience are best captured on self-reports of coping and emotion. Alternative approaches, such as art therapy and physical activity are effective in reducing clinical symptoms. Interventions relying on social support and social connections saw large effects on measures of self-reported resilience and changes in behaviour. And mindfulness and psychoeducational approaches are effective on outcomes related to well-being.

Conclusions and considerations for practice

The diversity of findings in resilience interventions does not negate the value and importance of resilience. Resilience continues to be a salient and meaningful construct. Liu et al. (2020)’s meta-analysis was a broad attempt to extract trends from the variable research to date. Rather than sweeping generalizations, findings emphasize the contextual specificity of resilience. There is no universal solution for increasing our resilience. Instead, the needs of the target population or individual, the types of risks and exposures they face, their levels of and access to existing resources and services, and the larger socio-cultural context they are situated within are all important considerations for intervention planning, development, and delivery. For researchers, these findings mean a need for model development and refinement of resilience conceptualizations that includes socio-structural determinants, while for clinical practice, efforts to increase resilience may first require asking more questions like for whom, with what needs, and under what circumstances.

Do resilience interventions work? Yes, but it depends on who’s asking.

Discussion Questions

  1. Are resilience interventions effective?
  2. What are the trends observed in resilience interventions?
  3. What contextual factors are important in the development and implementation of resilience interventions?

Reference Article

Liu, J. J. W., Ein, N., Gervasio, J., Battaion, M., Reed, M., & Vickers, K. (2020). Comprehensive meta-analysis of resilience interventions. Clinical Psychology Review, 82, 101919. https://doi.org/10.1016/j.cpr.2020.101919 

Author Bio

Jenny (Jing Wen) Liu, Ph.D., is a Postdoctoral Research Fellow in Psychiatry at the Toronto Western Hospital – Krembil Research Institute, University Health Network, and a Postdoctoral Fellow within Urban Health Equity Research at the Daphne Cockwell School of Nursing, Ryerson University. She is also an elected board member of the Society for the Study of Psychiatry and Culture, an international organization devoted to fostering cultural aspects of mental health and illness. Dr. Liu’s background is in psychological science, and her scholarship activities bridge research in stress and resilience with community-based applications.

References

Bolier, L., Haverman, M., Westerhof, G. J., Riper, H., Smit, F., & Bohlmeijer, E. (2013). Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health, 13, 119. https://doi.org/10.1186/1471-2458-13-119

Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58, 376-385. https://doi.org/10.1177/070674371305800702

Ferguson, C. J. (2009). An effect size primer: A guide for clinicians and researchers. Professional Psychology: Research and Practice, 40, 532-538. https://doi.org/10.1037/a0015808

Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: a critical evaluation and guidelines for future work. Child Development, 71, 543-562. https://doi.org/10.1111/1467-8624.00164

 Münch, N., Mahdiani, H., Lieb, K., & Paul, N. W. (2020). Resilience beyond reductionism: ethical and social dimensions of an emerging concept in the neurosciences. Medicine, Health Care and Philosophy. https://doi.org/10.1007/s11019-020-09981-0

Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: interdisciplinary perspectives. European Journal of Psychotraumatology, 5. https://doi.org/10.3402/ejpt.v5.25338

Watts, S. E., Turnell, A., Kladnitski, N., Newby, J. M., & Andrews, G. (2015). Treatment-as-usual (TAU) is anything but usual: a meta-analysis of CBT versus TAU for anxiety and depression. Journal of Affect Disorders, 175, 152-167. https://doi.org/10.1016/j.jad.2014.12.025

White, C. A., Uttl, B., & Holder, M. D. (2019). Meta-analyses of positive psychology interventions: The effects are much smaller than previously reported. PLoS One, 14, e0216588. https://doi.org/10.1371/journal.pone.0216588

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