Resumo

MONROY CORTES, Brisa Gissel  e  PALACIOS CRUZ, Lino. Resilience: is it possible to measure and influence it?. Salud Ment [online]. 2011, vol.34, n.3, pp.237-246. ISSN 0185-3325.

The objective of this work is to present a review about the concept of resilience, its biological aspects, the way we can try to measure it and some possible interventions. In Spanish, the term resiliencia is taken from the English word resilience or resiliency, term originally used in thermodynamics. In biological sciences, resilience is defined as <<the capability of an ecosystem or organism to recover its steadiness after it has suffered an alteration>>. In psychosocial research, Rutter defines resilience as <<the relative resistance to the psychosocial experiences of risk>>. For the resilience process to take place, it is necessary that individuals become exposed to an important stress and adversity load, and their efforts to contend them result in a positive adaptation in spite of suffering aggressions throughout the developmental process. When facing significant stress, three potential responses can be anticipated: 1. That individuals at risk show a better evolution than expected; 2. That a positive adaptation remains in spite of stressing experiences; or 3. That individuals reach an acceptable recovery after a trauma. The physiological response to the acute stress involves several neurotransmitters, neuropeptides and hormones, which have functional interactions that may produce a psychobiological response in the face of the acute stress and long term psychiatric consequences because they mediate mechanisms and neuronal paths that regulate reward, fear conditioning and social behavior. Cortisol, corticotropin-releasing hormone, norepinephrine, galanin, neuropeptide Y, dopamine and serotonin are some of the substances (physiological [or stress] mediators) implicated. After important stress exposure, we can say that a person has a resilient profile if his/her dehydroepiandrosterone (DHEA), neuropeptide Y, galanin, testosterone, 1A serotonin receptor (5HT1A) and benzodiazepine receptor levels are increased at the time that the hypothalamic-pituitary-adrenal axis (HPAA) and the locus coeruleus system functions are diminished. The biological factors associated with the acute and chronic stress can be considered a measure of resilience. For this purpose, the term allostasis, defined as the adaptive physiological response against the acute stress, has been proposed. Ideally, once the acute stress is suppressed, the individual is capable of recovering the state of homeostasis. However, if this does not occur and adaptive response against the acute stress persists or decreases only partially, it results in a harmful cumulative effect on the physiological and psychological functions of the individual. This phenomenon is denominated <<allostatic load>>. To evaluate the allostatic load it is necessary to incorporate information on the <<usual>> levels of each individual's allostasis, and to evaluate the dynamics of the systems and the parameters of the main regulation systems. The parameters to evaluate the allostatic load are: a) Arterial systolic pressure >148 mmHg and arterial diastolic pressure >83 mmHg, which are the cardiovascular activity index; b) Waist-hip index > 0.94, that reflects the chronic metabolism function and the disposition of body fat; c) The total cholesterol/high density lipids (HDL)relation in serum >5.9, related with the development of atherosclerosis; d) Glycosylated hemoglobin levels >7.1%, to identify the average of plasma glucose concentration over prolonged periods of time; e) Dehydroepiandrosterone sulfate (DHEA-S) <350 ng/ml, a functional antagonist of the HPAA; f) Nocturnal urinary cortisol excretion ratio >25.7 ug/g creatinine, which measures the 12 hours HPAA activity; g) Nocturnal urinary adrenaline >48 ug/g creatinine, and noradrenaline excretion >5 ug/g creatinine; this test integrates the 12-hours indexes of the sympathetic nervous system activity. The appropriate study of resilience requires consideration to other aspects influencing its nature besides the biological ones. Some of them are: a) The risk factors, defined as events or conditions of adversity associated with the presence of psychopathology or dysfunctional development; b) The vulnerability factors, that is, the features, genetic biases and environmental or biological deficiencies which increase the stress and risk factors response; and c) The protective factors, described as features, contextual characteristics and interventions that promote the resistance, or moderate the effects, to the risk factors. The protective factors are associated with health and functional development; therefore, they promote resilience and offer new options to cope with the event. These factors are studied in three areas: those characteristic of children, in the family atmosphere and in the community. The characteristic factors of children are: intelligence, temperament, flexibility, sense of humor and self-esteem. Related to these a number of annotations have been made. For instance, in certain individual intelligence is modified due to a sequence of stress exposure, like family violence. Individuals with a <<resistant>> personality experience more trust and are better prepared to apply their abilities and take advantage of their social support; likewise, cooperativeness, kindliness and tolerance are characteristics that could help the child to deal with the presence of harsh conditions; and finally, people with a high opinion of themselves seem to be more resistant to stressing events. The factors of the family atmosphere are: maltreatment, parental loss, attachment and support, discipline and surveillance, carefulness and parents' mental illness. Regarding these factors it is possible to say that abuse can result in a disturbance of the normal development. Whereas a good care quality educational opportunities, appropriate nutrition and support from the community to the families, during the early childhood, propitiate a positive development at a cognitive, social and self-regulation level in both children and adolescents. It is known that resilient boys come from homes with structure and rules. For these children, the role of a healthy and reliable paternal figure serves as a model for identity and for the appropriate emotional expression. Instead, the resilient girls develop in homes that combine the emphasis in the taking of risks as well as the independence, besides they are supported by a caregiver. Finally, the factors in the community are: violence, social networks and neighborhood. It has been recognized that children who live in violent neighborhoods have a high risk of developing internalized and externalized disorders. Nevertheless, the acceptance of their peers and their friendships can attenuate their family adversity, what surely helps them to acquire social abilities; in that same direction, an appropriate social organization can reduce the impact of poverty and violence in the community. It is important to mention that these factors continually interact with each other (and should not be seen in an isolated way) in what we call adaptive systems, those which directly contribute to the satisfactory adjustment or recovery of balance after the exposure to one or more adverse events. When these adaptive systems are available and work properly, the individuals are said to be resilient. We know that in these adaptive systems, mainly in the first stages of life, a disturbance can exist as a consequence of chronic or acute exposure of the individual to adversity. The adaptive systems are as follows: learning, attachment, motivation, response to stress, selfmodulation, family, school, pairs, cultural and social systems.

Palavras-chave : Stress; allostasis; allostatic load; resilience.

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