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Therapeutic techniques can enhance psychological resilience and may help patients improve their quality of life. Here's how.
Editor's note: This work is the focus of a presentation on resilience-building interventions and aging at APA.
The global population is aging rapidly. Over the next 4 decades, the number of individuals 60 years and older will nearly triple to more than 2 billion in 2050. With the aging of the population, the burden and cost of chronic disease will escalate worldwide. To ensure healthy and successful aging and to reduce the cost of care, building resilience and wellbeing among the aging becomes a top priority for individuals, families, and society at large.
Resilience to stress is one of the factors that has had numerous meanings in prior research. But resilience generally refers to a pattern of functioning that indicates a positive adaptation in the context of adversity. People who are resilient display a greater capacity to quickly regain equilibrium physiologically and psychologically following stressful events, and are able to sustain it in the face of adversity.
In a broader sense, resilience refers to the ability to maintain biological and psychological homeostasis under stress. However, components of resilience may vary with context, time, age, gender, and cultural origin. The question remains whether a certain level of adversity or a threshold is required before resilience becomes a meaningful concept, or if resilience can be viewed as a dynamic process of adaptation to everyday challenges of growing old. The latter appears to be more useful in explaining longevity and successful aging.
A coherent pattern has emerged of individual characteristics associated with resilience and successful adaptation. Salient characteristics include commitment, dynamism, humor in the face of adversity, patience, optimism, faith, and altruism. There are emotional and cognitive aspects of resilience that can be innate or learned. The innate affective or emotional styles that are likely to influence resilience refer to the individual styles of affect regulation, which is usually a part of personality structure (eg, optimism or pessimism), or social intelligence.
Protective temperamental factors include sociability, intelligence, social competence, internal locus of control, warmth and closeness of affectional ties, and active emotional support within the family network or within religious groups. As such, resilience may represent an important target of treatment and prevention in anxiety, depression, and abnormal stress reactions in aging.
The question remains whether resilience can be operationalized for training and taught to older individuals coping with daily stress to boost resistence to stress and life’s adversities.
Can happiness be learned?
Therapeutic techniques that enhance psychological resilience may help overcome disability and improve quality of life. Several psychotherapeutic approaches have already demonstrated promise in building resilience, such as positive affect skill-building (eg, in cognitive behavioral or well-being therapy) in individuals with depression. Other approaches with documented success in building a positive attitude include gratitude, positive reappraisal, focusing on personal strengths and attainable goals, and altruism and volunteerism.
Successful stress-reduction and management in the vulnerable elderly can help prevent serious mental and physical illness. Integrated modalities to improve resilience and reduce stress in combination with pharmacotherapy and lifestyle changes are likely to improve the overall functioning and well-being of older adults.
Lifestyle changes can potentially improve resilience by providing better health and enhancing the sense of well-being. Large-scale epidemiological studies demonstrate a strong relationship between diet and inflammation and disorders such as depression or heart disease. Diets high in refined grains, processed meat, sugar, and saturated- and trans-fatty acids and low in fruits, vegetables, and whole grains promote inflammation.
High-fat meals can increase glucose levels and triglycerides, which stimulate production of IL-6 and CRP. In contrast, higher fruit and vegetable intake is associated with lower inflammation, which may counteract pro-inflammatory responses to high-saturated-fat meals. Therefore, improved nutritional intake is likely to have clinical benefit on health and wellbeing through anti-inflammatory pathways.
Exercise has also been shown to be important in maintaining well-being in older adults. Exercise intensity, duration, frequency, and other factors appear to play important roles in anti-aging outcomes, as does physical training. Human and other animal studies demonstrate that exercise targets many aspects of brain function and provides broad effects on overall brain health. The benefits of exercise have been best defined for learning and memory, protection from neurodegeneration, and alleviation of depression-particularly in elderly populations.
Exercise increases synaptic plasticity by directly affecting synaptic structure and potentiating synaptic strength, as well as by strengthening the underlying systems that support plasticity, including neurogenesis, metabolism, and vascular function. Such exercise-induced structural and functional change has been documented in various brain regions but has been best studied in the hippocampus.
Randomized and crossover clinical trials demonstrate the efficacy of aerobic or resistance-training exercise (2 to 4 months) as a treatment for depression in both young and older individuals.1,2 The benefits are similar to those achieved with antidepressants. Therefore exercise appears to be a powerful intervention that has mood enhancing effects, thereby promoting wellbeing and therefore resilience.
Complementary and integrative medicine
Complementary and integrative medicine (CIM) is well positioned to offer interventions that lead to rebalancing and enhancing resilience, which in turn can help prevent major mental and physical diseases of aging. With aging baby boomers expected to accelerate use of CIM, the importance of mental health professionals having a working knowledge of CAM techniques intended to address late life mood disorders becomes increasingly clear.
Studies already report increasing use of mind-body medicine in the US, especially meditation, imagery, and yoga. Mindfulness and mindfulness-based stress reduction can be taught to anybody who can understand instructions, and they impart stress-reducing techniques that can reduce suffering.
Humor and laughter therapy also promote healing and well-being. In 1995 in Bombay, India, Madan Kataria founded Laughing Clubs International by simply inviting people to laugh in a park each morning before work. Today there are over 3000 laughing clubs throughout the world, including the US. Physiologically, laughter can increase breath, aid circulation, release endorphins, protect the immune system, and tone muscles. And laughter can be easily shared with others.
Mind-body medicine encompasses a number of techniques collectively known as mindful exercise (eg, yoga, Qigong, and Tai Chi), or meditation. Mindful physical exercise has become an increasingly utilized approach for improving psychological well-being and is defined as “physical exercise executed with a profound inwardly directed contemplative focus.” In general, mindful physical exercise contains the following key elements:
• A non-competitive, non-judgmental meditative component
• Mental focus on muscular movement and movement awareness combined with a low to moderate level of muscular activity
• Centered breathing
• A focus on anatomic alignment (ie, spine, trunk, and pelvis) and proper physical form
• Energy centric awareness of individual flow of intrinsic body energy, otherwise known as prana, life force, qi, or Kundalini
The mindful exercise has been shown to provide an immediate source of relaxation and mental quiescence. Scientific evidence has shown that medical conditions such as hypertension, cardiovascular disease, insulin resistance, depression, and anxiety disorders respond favorably to mindful exercises. In our pilot studies of Kirtan Kriya vs relaxation in stressed dementia caregivers, we also documented epigenetic changes in genes related to anti-inflammatory pathways, increase in telomerase activity, and decreased peripheral inflammation along with improved mental health.3,4
Despite rapidly growing numbers of aging adults, many are invested in aging well and in preventive practices for all disorders of aging. Some of these preventive techniques include stress reduction that will enhance resilience to stress. Many of these techniques can be learned outside of the medical system and include lifestyle changes, mindfulness, and mindful exercise, and any joyful activities that can enhance the quality of life of older adults and their families.
For more information
• Lavretsky H. Resilience and Aging: In Research and Practice. Baltimore, Md. Johns Hopkins University Press. 2014.
• Lavretsky H, Sajatovic M, Reynolds CF. Complementary, Alternative and Integrative Interventions for Mental Health and Aging. Oxford University Press. 2016.
Dr Lavretsky is Professor of Psychiatry and Director of the Late Life Mood, Stress, and Wellness Program at the Semel Institute for Neuroscience and Human Behavior at the David Geffen School of Medicine at UCLA. She is also a Semel Scholar in Integrative Mental Health. This work was supported by the NIH grants MH86481, MH097892, AT008383, Forest Research Institute, and Alzheimer’s Research and Prevention Foundation to Dr Lavretsky.
1. Awick EA, WÃ³jcicki TR, Olson EA, et al. Differential exercise effects on quality of life and health-related quality of life in older adults: a randomized controlled trial. Qual Life Res. 2015; 24:455-462.
2. Gudlaugsson J, Gudnason V, Aspelund T, et al. Effects of a 6-month multimodal training intervention on retention of functional fitness in older adults: a randomized-controlled cross-over design. Int J Behav Nutr Phys Act. 2012;9:107.
3. Lavretsky H, Epel ES, Siddarth P, et al. A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity. Int J Geriatr Psychiatry. 2013;28:57-65.
4. Black DS, Cole SW, Irwin MR, et al. Yogic meditation reverses NF-ÎºB and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trial. Psychoneuroendocrinology. 2013;38:348-355.