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Abstract

As clinicians and the public move from a pathological (disease-focused) to a salutogenic (health-focused) understanding of the human condition, protective factors contributing to the health of individuals and societies have received more attention. The study of resilience is a foundational aspect of this critical shift and a promising way to understand and interpret our responses to complex multi-domain perturbations from stressful and traumatic experiences. However,as researchers from different fields engage in resilience research, a plethora ofdefinitions and understandings have emerged requiring detailed academic discourse. Rapidly changing global, political, economic and environmental circumstances highlight the need for effective solutions to understand and enhance resilience. These solutions require a multidisciplinary understanding of the concept of resilience.
, 20140057, published 22 August 20144 2014 Interface Focus
Shamini Jain, Meredith Sprengel, Kevin Berry, John Ives and Wayne Jonas
The tapestry of resilience: an emerging picture
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Introduction
Cite this article: Jain S, Sprengel M, Berry K,
Ives J, Jonas W. 2014 The tapestry of resilience:
an emerging picture. Interface Focus 4:
20140057.
http://dx.doi.org/10.1098/rsfs.2014.0057
One contribution of 9 to a Theme Issue
‘Towards a systems model of resilience’.
Subject Areas:
systems biology
Keywords:
resilience, health, systems
Author for correspondence:
Meredith Sprengel
e-mail: msprengel@siib.org
The tapestry of resilience: an emerging
picture
Shamini Jain, Meredith Sprengel, Kevin Berry, John Ives and Wayne Jonas
Samueli Institute, Alexandria, VA 22314, USA
As clinicians and the public move from a pathological (disease-focused) to a
salutogenic (health-focused) understanding of the human condition, protec-
tive factors contributing to the health of individuals and societies have received
more attention. The study of resilience is a foundational aspect of this critical
shift and a promising way to understand and interpret our responses to complex
multi-domain perturbations from stressful and traumatic experiences. However,
as researchers from different fields engage in resilience research, a plethora of
definitions and understandings have emerged requiring detailed academic
discourse. Rapidly changing global, political, economic and environmental
circumstances highlight the need for effective solutions to understand and
enhance resilience. These solutions require a multidisciplinary understanding
of the concept of resilience.
In January 2012, Samueli Institute convened a meeting entitled ‘Towards a
systems model of resilience: state of the science and future directions’ held at the
National Academy of Sciences’ Beckman Center to help bridge the current gaps
in understanding interdisciplinary approaches to the study of resilience and to
encourage cross-discipline dialogue on the potential promise of creating sys-
tems models of resilience. Prominent scientists in scientific fields such as
systems biology, systems engineering, mathematics, biology, psychoneuroim-
munology, psychoneuroendocrinology, sociology, medicine and psychology,
along with key Department of Defense leaders, gathered to both share perspec-
tives and explore the possible utility of creating interdisciplinary, systems-based
models for understanding resilience. The meeting was highly successful in
engendering collaborative education and enthusiasm for forwarding the
study of resilience in an interdisciplinary and systems-oriented fashion. In
this Theme Issue of Interface Focus, we summarize findings that arose from a
first major effort to explore resilience from a diversity of disciplines and per-
spectives. The culmination of these efforts is a rich tapestry of views, ready
to be woven into a coherent whole.
The classical Latin-origin definition of resilience (resili (ens), present participle
of resilire—to spring back, or rebound) was used to describe the tensile properties
of material objects (also known as elastic memory) such as wood and metals
[1]. This conceptualization of resilience is understood as ‘recoiling’ to an original
state after a perturbation. Since the use of the term in the early 1800s, the concept
of resilience has been applied to many fields of human endeavour, including the
study of ecosystems and human responses to adverse conditions such as natural
disasters, war and personal loss [2]. Although this Theme Issue is focused on the
domain of health-oriented resilience, the study has expanded to include many
disciplines such as politics, diplomacy and economics, to name a few.
While the interest and efforts in studying resilience expand, our understand-
ing of what resilience is and how best to enhance it in various contexts remains
fragmented. A consensus definition of the term resilience has not come to frui-
tion, although several themes emerge from the existing data. A literature search
conducted by the RAND Corporation unearthed 122 definitions of resilience.
Three major themes emerge from these varied definitions that indicate our cur-
rent understanding of resilience as (i) a dynamic process (rather than as a ‘trait’)
that evolves across time, (ii) adaptability to change and, generally, to adversity,
and (iii) either a return to homeostasis, or an enhanced state of functioning
(e.g. growth) [3]. When examining resilience as a response to adversity, our cur-
rent understanding needs to expand beyond the concept of a return to
homeostasis, to instead a new normal that is characterized by stability through
&2014 The Author(s) Published by the Royal Society. All rights reserved.
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change. Being resilient entails more than the ability not only to
adjust and adapt to a perturbation, but also to transform when
the perturbation requires a new conceptualization of the way in
which to effectively proceed forward. This process does not
return an individual or system to a previous homeostatic set-
point. Rather, the concept of resilience uses learning from
prior experiences to effectively adapt by anticipating and pre-
dicting current needs, and modifying feedback inputs to
achieve maximal efficiency of that system within a particular
context and timeline. This evolution in understanding resili-
ence from a dynamic perspective is consistent with a control
systems model of allostatic, versus homeostatic, regulation
[4]. The relationship between adversity and enhanced resili-
ence has been documented previously; non-specific resilience
is enhanced by prior moderate stressors [5– 7]. In other
words, resilience does not occur and cannot be detected out-
side of a stressor or changing context. However, individuals
with a history of high adversity report decreased well-being
and psychological functioning. The act of being resilient is an
adaptive response to stressors that is, ultimately, dependent
on context. The most common reaction and/or response to a
traumatic incident is resilient behaviours: ‘although symptom
levels tend to vary for different potentially traumatic events,
resilience has consistently emerged as the most common
outcome trajectory’ [8, p. 136].
Fully understanding resilience requires systems approa-
ches that facilitate the modelling of dynamic interactions in
multiple domains (e.g. psychological, physical and social)
within a person and between his or her social and physical
environment. There is an increasing interest in systems-based
approaches to understanding resilience between people and
their surrounding environments, such as those in socio-
ecological systems [9,10]. Reductionist approaches used by
some researchers when developing and testing hypotheses
about resilience separate the person from his/her environment
or subjugate the environmental variable when performing
analyses. In these analyses, the environment only becomes
an important variable when ‘it provides a forum in which
resilience-promoting-processes that contribute to individual
growth take place’ [11, p. 4]. As a consequence, outcomes
remain void of cultural, historical and political constructs [12].
The structure of our current academic systems facilitates
highly specialized, narrowly focused disciplines that often do
not promote opportunities to effectively communicate across
fields of study. Specialization generates monumental progress
within our isolated fields of discipline and allows us to use
more precise tools for examining parts of the whole. However,
it also constructs barriers to integrated thinking required for
solving complex scientific puzzles such as resilience. Ongoing
cross-discipline dialogue will be essential for fostering a com-
plete understanding of resilience within the whole person
and his/her environment. Models of resilience that incorporate
mental, emotional, social and physical processes will be maxi-
mally effective in helping understand and enhance resilience
within individuals and societies.
The meeting held addressed the pressing need to induce
dialogue across various disciplines and among academics
studying resilience. The publications in this Theme Issue of
Interface Focus on resilience reflect some of the thinking and
research on resilience from academic experts who attended,
as seen through their particular scientific lens. Several articles
reflect the promise of systems-based modelling approaches
for helping solve issues related to physiological resilience.
We now move to a discussion of these articles, starting
with the articles that describe the value of systems modelling
approaches to understanding resilience in medical and phys-
iological settings. We then continue our discussion noting
the articles that discuss systems thinking surrounding
mind–body interventions for enhancing resilience, and con-
clude with the articles that discuss resilience within military
contexts and other social settings.
Csete & Doyle’s [13] article, ‘The mathematician’s toolbox
for management of type 1 diabetes’, offers a non-technical
summary of the utility of control systems modelling in the
development of the artificial pancreas, noting both its
promise and shortcomings. It also provides the reader with
an opportunity to reflect on the utility of control engineering
tools to better understand and enhance resilience within
medical settings. Aschbacher et al.’s [14] study entitled ‘The
hypothalamic–pituitary adrenal– leptin axis and metabolic
health: a systems approach to resilience, robustness and
control’ further explores the utility of control systems tools
and thinking in its exploration of robustness as a key indicator
of stress system resilience. This study employs relatively
simple, yet novel systems-based mathematical tools to examine
the dynamics of the HPA–leptin feedback sensitivity—these
dynamics predicted metabolic risk in the population studied,
whereas traditional neuroendocrine measures did not. The
study, along with Aschbacher’s previous work, points to the
promise of using dynamic systems modelling approaches in
the field of psychoneuroendocrinology to better understand
mind– brain–body relationships as they relate to resilience.
Vodovotz’s [15] article, ‘Computational modelling of the
inflammatory response in trauma, sepsis, and wound healing:
implications for modelling resilience’, also speaks to the promise
of employing systems modelling approaches to the study of
sepsis, an acute inflammatory response to a noxious agent
that can be life-threatening. This article provides an overview
of the relevance of both data-driven and mechanistic models
for understanding and predicting acute inflammation, and
suggeststhe promise of integrating both approaches for under-
standing inflammation that may be used clinically. Vodovotz
provides a provocative hypothesis that inflammation may be a
key factor in understanding resilience at the whole organism,
under the skin, level, and proposes some methods by which
this hypothesis could be tested.
Irwin’s [16] review on ‘Sleep and inflammation in resilient
aging’ builds on this theme by discussing the complex relation-
ships between sleep, inflammation and resilient aging, noting
that high versus poor sleep quality may act as a resilience-
enhancing or perturbing factor, respectively, within the context
of aging. Irwin reviews the data for sleep’s relationship to resi-
lient aging as well as its relationship to resilience-interfering
factors such as depression, pain, morbidity and mortality in
the elderly. Irwin further suggests that proper sleep may
buffer increases in inflammation that are found for aging
populations, speaking to the promise of behavioural inter-
ventions that improve sleep quality as a method of enhancing
psychobiological resilience in the elderly.
Similarly, in Silverman & Deuster’s [17] review, ‘Biological
mechanisms underlying the role of physical fitness in health
and resilience’, the biological systems that may underlie the
impact of physical fitness on resilience and health are discussed.
The authors suggest that physical fitness may enhance psycho-
physiological resilience through multiple pathways, including
by optimizing neuroendocrine and psychosocial reactivity to
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stressors, as well as by reducing tonic levels of inflammation
and enhancing neuroplasticity and growth factor expression.
Similar to Irwin, the authors call for the need for easily imple-
mentable behavioural strategies such as exercise to enhance
human resilience, as a self-modifiable characteristic.
Understanding resilience includes investigating key bio-
logical factors that may play a role in identifying resilience
within the context of traumatic stress. This is a key to helping
individuals who are required to engage in highly stressful
and life-threatening scenarios such as war fighting, disaster
scene search and rescue, civil disturbance response, fire and
police work. The thoughtful and thorough commentary by
Litz [18] entitled ‘Resilience in the aftermath of war trauma:
a critical review and commentary’ illustrates the complexity
of understanding resilience in the context of war trauma,
and speaks to the need for us to carefully develop effective
assessment, prevention and treatment strategies to enhance
resilience to war trauma within various contexts and across
the deployment cycle.
Yehuda et al.’s [19] article also discusses resilience factors
within the context of traumatic stress. In the article, ‘Gluco-
corticoid related predictors and correlates of post-traumatic
stress disorder treatment response in combat veterans’, the
authors examined the potential relevance of glucocorticoid
variables in predicting responses to psychotherapeutic treat-
ment for post-traumatic stress disorder (PTSD). Interestingly,
the study indicated that both prolonged exposure and a mini-
mal attention control considerably reduced PTSD symptoms
over time. Genotype for the glucocorticoid receptor (BCLI
polymorphism), as well as pre-treatment levels of neuropep-
tide Y, predicted treatment responses, and 24 h urine cortisol
levels as well as glucocorticoid sensitivity appeared to be
sensitive biomarkers of change in response to the interven-
tion. The study indicates the promise of systems-oriented
approaches ( psychoneuroendocrinology) in linking mind
body processes associated with resilience and the potential
value of neuroendocrine biomarkers in predicting risk and
resilience to PTSD. Finally, related to systems models on
social resilience, Pincus’s [20] article, ‘One bad apple: exper-
imental effects of psychological conflict on social resilience’,
demonstrates both the impact of individual-level conflict on
higher-order (group) systems, and the value of dynamic ana-
lyses in assessing potential ‘ripple effects’ related to the social
domain of resilience.
This tapestry of articles reflects the varied approaches and
levels of investigation that are apparent in understanding
human resilience today. We note that this is far from a com-
plete representation of the breadth of the current theory and
investigation that comprises the study of resilience. It does
not at this point reflect the integration of cross-discipline
thinking and collaboration that the future may hold.
However, the integration of these multiple perspectives on
resilience as reflected is the first necessary step towards a
truly whole systems model of resilience. We are confident
that the breadth and overlapping nature of the current articles
will be both informative and interesting to the reader and
help the scientific community better understand the current
terrain of inquiry surrounding the study of resilience.
Funding statement. This Research program is supported by DoD/TATRC
W81XWH1120173, entitled ‘Central Evaluation of Resilience Programs
(CERP)’.
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... Resilience has received greater interest in the stress and trauma fields in understanding the human condition (Jain et al., 2014;Kalischi et al, 2015). Resilience scholars investigate health, rather than disease; therefore, the focus is on approaches to avert illness (Jain et al., 2014;Kalischi et al, 2015). ...
... Resilience has received greater interest in the stress and trauma fields in understanding the human condition (Jain et al., 2014;Kalischi et al, 2015). Resilience scholars investigate health, rather than disease; therefore, the focus is on approaches to avert illness (Jain et al., 2014;Kalischi et al, 2015). Resilient people possess certain beliefs (Shakespeare-Finch & Wickham, 2010) and the ability to take control of situations and make meaning of their situations (Hutchinson & Dorsett, 2012;Lenette et al. 2012;West et al. 2012). ...
... Socio-ecological approaches emphasize the vital role of environmental resources like support from family, friends, and one's ethnic community (Babatunde-Sowole et al., 2016;Schweitzer et al. 2007;Ungar 2011); and available services rather than individual traits or cognitions alone. Consequently, resilience involves dynamic interactions occurring between an individual and their social and physical environment (Jain et al., 2014;Lenette et al., 2012). Rashid et al. (2013) referred to the post-migration life of migrant women as only a partially visible portion of their existence. ...
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Migrants from areas affected by war, especially refugee migrants, are susceptible to mental health issues. In addition to recognising trauma, health professionals, such as mental health nurses, need to be aware of the strength and resilience of refugees and migrants. The capacity to provide trauma‐informed care that is shaped by the recognition of clients’ strength and resilience is required/paramount to meet the current demand of multiculturalism emanating from an increased global migration. To facilitate increased awareness about West African women’s resilience prior to migration and support trauma‐informed care, we used a qualitative strength‐based storytelling approach with 22 West African women residing in Sydney, Australia. Thematic analysis of the women’s stories identified two major themes: When the World Falls Apart and Battered but Strong. Findings revealed that past personal experiences significantly influenced participants’ strength and resilience and contributed to their mental health. Mental health professionals such as nurses can play an important role by incorporating knowledge about the resilience of migrants and refugees into providing appropriate trauma‐informed care.
... Trefois et al. pointed out the potential value of translating the generic hypothesis of dynamical systems theory to medicine [8]. Jain et al. concluded the following about resilience: "When examining resilience as a response to adversity, our current understanding needs to expand beyond the concept of a return to homeostasis, to instead a new normal that is characterized by stability through change" [36]. This accentuates the importance of viewing resilience as a dynamic concept. ...
... Adaptability is the capacity of a system to anticipate changes, so that it retains its stability [36,40]. Jain et al. and Resnick et al. described adaptability as a part of resilience. ...
... Jain et al. and Resnick et al. described adaptability as a part of resilience. It is a trait or characteristic needed in order to be resilient [36,41]. To be clear, it is not a state or basin of attraction. ...
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Rationale: Resilience is a relatively new concept in medicine and, more specifically, it is new in geriatrics. It suits the new definition of health as introduced by Machteld Huber. However, resilience still needs a suitable, operationalizable definition for the field of geriatrics, given that it is still an emerging theme in medicine.Resilience in different disciplines: Investigation of the concept of resilience in mechanics, ecology, psychology and sociology shows that resilience is mostly considered as a dynamic, multidimensional and scalable concept. As such it may also apply to the field of medicine and potentially also to the field of geriatrics. However, the idea of resilience is still evolving. Therefore, time is needed to develop a common understanding of the concept. When this understanding is enhanced, operationalization is of great importance. Current operationalization in these disciplines varies from questionnaires to establish (static) characteristics defining a state that is prognostic for the resilience to be shown when perturbated to stress-tests, to mathematical indicators which evaluate the dynamic response or behavior of the system to (standardized) perturbations.Discussion: All measurements for operationalization are indicators of resilience and do therefore not directly measure resilience (if this is indeed possible). In addition, there is not only one concept of resilience. Resilience can be considered objectively as a systems characteristic, or subjectively, for example by gestalt. These different approaches cause a gap between the concepts and different operationalizations, which makes it difficult to operationalize the (general) concept of resilience.Implications and recommendations: Over time, resilience can potentially be measured by the use of new measurements, longitudinal data and wearables. For implementation in the clinic, validation of the measures is key. In addition, qualitative research on how the elderly experience, or would describe, resilience is recommended, in order to gain a better understanding about the concept. Then, there can be thought of intervening in resilience, especially in patients who face transition to another state of health.
... Physical resilience is distinct from the well-studied, and important, construct of psychological resilience. 1,2 Whereas psychological resilience refers to a person's ability to adapt well in the face of adversity, trauma, tragedy, threats, or significant sources of stress, [3][4][5] physical resilience focuses on maintenance or recovery of function after biomedical or pathological challenges. 6 Physical resilience is presumed to reflect adaptive physiological responses at the level of organs, cells, and molecules (e.g., musculoskeletal, neurological, immunological processes) that support homeostasis under changing conditions. ...
... One way to maintain health and function across the life span is to minimize the detrimental effects of injury, illness, or other stressors that inevitably occur in life. The concept of resiliency, the tendency to remain well or "bounce back" in the face of adversity, is not new (5). Resiliency was originally used to denote the elastic property of materials (6), but "resilience" has since been applied to systems, communities, and individuals. ...
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... The military family is critical to a service member's resilience and performance. 2 One of the many roles of the military health system is to support the service member and family. Today, this role is more important than ever. ...
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