Biopsychosocial approach to understanding resilience: Stress habituation and where to intervene

J Eval Clin Pract. 2018 Dec;24(6):1339-1346. doi: 10.1111/jep.13052. Epub 2018 Oct 18.


Background: Resilience in the face of adversity is a human experience that leads to better health, both mentally and physically. We briefly review its historical origins rooted in ecological biology and its adoption into health care. Resilience is the common response to adversity or potential traumatic events. Individual differences in emotion regulation and coping skills as well as social capital and one's physical environment influence a person's ability to achieve resilience.

Proposed mechanism: One potential biopsychosocial measure of resilience includes stress habituation to repeated stress as demonstrated in the laboratory, possibly providing a tool to observe mastery of resilience training in the clinic. Evidence-based interventions at the individual and small group level (eg, family, classroom) have successfully shown development of resilient behaviours and improved mental and physical health outcomes. However, the role of social context and public policy clearly influence an individual's ability to be resilient.

Conclusions: Despite the current limited evidence of the effectiveness of resilience building interventions, clinicians, researchers, and other health care professions have an obligation to become advocates for laws and policies that support the most vulnerable, and least resilient, in our society to attain resilience for their health. This salutary effect will enable them to become socially as well as economically productive members of the community at large. It is not possible to remove stress or adversity from life, but we can influence the development of regulatory flexibility and decrease the sociocultural factors linked to the nonresilient experience, thus mitigating adversity's long-term effects on health.

Keywords: adversity; biopsychosocial; complex adaptive systems; health care professional; intervention; repeat stress paradigm; stress.

MeSH terms

  • Adaptation, Psychological*
  • Communication
  • Delivery of Health Care / organization & administration*
  • Emotions
  • Environment
  • Health Status
  • Humans
  • Hypothalamo-Hypophyseal System / metabolism
  • Mental Health
  • Pituitary-Adrenal System / metabolism
  • Professional-Patient Relations
  • Resilience, Psychological*
  • Social Environment
  • Social Support
  • Stress, Psychological / physiopathology*
  • Stress, Psychological / psychology*
  • Sympathetic Nervous System / metabolism