Primary and secondary resilience to stress-related disorders and suicidal behavior

To the Editor

Resilience is defined as the ability and dynamic process of adaptively overcoming stress and difficulties while maintaining normal psychological and physical function (Sher, 2019). Resilience is associated with healthy development, positive health outcomes and ability to withstand life stressors. Building resilience may reduce the incidence of stress-related disorders and suicide rates in the general population (Sher, 2019). Resilience enhancement may reduce suicides among individuals with stress-related and other psychiatric disorders (Sher, 2019).

Resilience research is focused on recognizing the psychosocial and neurobiological factors of resilience (Sher, 2019). According to the current views, resilience is associated with multiple factors, including positive emotions and optimism, the ability to regulate emotions, cognitive flexibility, a history of mastering challenges, commitment to a valued cause or purpose, capacity to extract meaning from adverse situations, high coping self-efficacy, disciplined focus on skill development and altruism. Resilience factors may be more important predictors of stress-related disorders and suicidal behavior than the extent of exposure to stressful life events.

Resilience may mean not only that someone reacts to stress more adaptively, but that someone actively creates a world in which stressful situations are less likely to take place (Price, 2016). I suggest to call this ability to create a stress-free world ‘primary resilience’ while the ability to adapt well in the face of stress and adversity can be termed ‘secondary resilience’.

The literature on resilience is mostly focused on secondary resilience to stress-related disorder and suicide. However, primary resilience is very important. Many individuals with psychiatric disorders and/or maladaptive personality features who are predisposed to stress-related disorders and suicidal behavior play an active part in creating the very stressors (e.g. interpersonal arguments) that then affect them (Liu and Alloy, 2010). For example, according to the stress generation theory, depression-prone individuals are not merely inert respondents to stressful events in their lives, but they actively create depressogenic life stressors. Certain cognitive and personality factors have been implicated in the stress generation (Liu and Alloy, 2010).

Public education and psychotherapeutic interventions should aim at teaching healthy and sick people on how to create an environment in which stress is less likely to occur. For example, some people need to be taught to be more assertive and deal with issues head on, doing their best to anticipate and prevent problems. Interventions with individuals with a history of stress-generation behavior should focus on behavior modification strategies targeting stress generation mechanisms.