The Frequent Stressor and Mental Health Monitoring-Paradigm: A Proposal for the Operationalization and Measurement of Resilience and the Identification of Resilience Processes in Longitudinal Observational Studies

Raffael Kalisch; Göran Köber; Harald Binder; Kira F Ahrens; Ulrike Basten; Andrea Chmitorz; Karmel W Choi; Christian J Fiebach; Nele Goldbach; Rebecca J Neumann; Miriam Kampa; Bianca Kollmann; Klaus Lieb; Michael M Plichta; Andreas Reif; Anita Schick; Alexandra Sebastian; Henrik Walter; Michèle Wessa; Kenneth S L Yuen; Oliver Tüscher; Haakon Engen

doi:10.3389/fpsyg.2021.710493

The Frequent Stressor and Mental Health Monitoring-Paradigm: A Proposal for the Operationalization and Measurement of Resilience and the Identification of Resilience Processes in Longitudinal Observational Studies

Front Psychol. 2021 Aug 26:12:710493. doi: 10.3389/fpsyg.2021.710493. eCollection 2021.

Authors

Raffael Kalisch^{1

2}, Göran Köber^{3

4}, Harald Binder^{3

4}, Kira F Ahrens⁵, Ulrike Basten^{6

7}, Andrea Chmitorz^{1

8

9}, Karmel W Choi^{10

11

12}, Christian J Fiebach^{6

13}, Nele Goldbach⁵, Rebecca J Neumann⁵, Miriam Kampa^{1

14

15}, Bianca Kollmann^{1

8}, Klaus Lieb^{1

8}, Michael M Plichta⁵, Andreas Reif⁵, Anita Schick^{1

2

16}, Alexandra Sebastian⁸, Henrik Walter¹⁷, Michèle Wessa^{1

18}, Kenneth S L Yuen^{1

2}, Oliver Tüscher^{1

8}, Haakon Engen^{2

19}

Affiliations

¹ Leibniz Institute for Resilience Research, Mainz, Germany.
² Neuroimaging Center, Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center, Mainz, Germany.
³ Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
⁴ Freiburg Center of Data Analysis and Modelling, University of Freiburg, Freiburg, Germany.
⁵ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany.
⁶ Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany.
⁷ Department of Psychology, University of Koblenz-Landau, Landau, Germany.
⁸ Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center, Mainz, Germany.
⁹ Faculty of Social Work, Health Care and Nursing Science, Esslingen University of Applied Sciences, Esslingen, Germany.
¹⁰ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
¹¹ Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States.
¹² Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
¹³ Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany.
¹⁴ Department of Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany.
¹⁵ Department of Psychology, Bender Institute of Neuroimaging, Justus Liebig University, Gießen, Germany.
¹⁶ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
¹⁷ Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
¹⁸ Department of Clinical Psychology and Neuropsychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany.
¹⁹ Department of Psychology, University of Oslo, Oslo, Norway.

Abstract

Resilience has been defined as the maintenance or quick recovery of mental health during and after times of adversity. How to operationalize resilience and to determine the factors and processes that lead to good long-term mental health outcomes in stressor-exposed individuals is a matter of ongoing debate and of critical importance for the advancement of the field. One of the biggest challenges for implementing an outcome-based definition of resilience in longitudinal observational study designs lies in the fact that real-life adversity is usually unpredictable and that its substantial qualitative as well as temporal variability between subjects often precludes defining circumscribed time windows of inter-individually comparable stressor exposure relative to which the maintenance or recovery of mental health can be determined. To address this pertinent issue, we propose to frequently and regularly monitor stressor exposure (E) and mental health problems (P) throughout a study's observation period [Frequent Stressor and Mental Health Monitoring (FRESHMO)-paradigm]. On this basis, a subject's deviation at any single monitoring time point from the study sample's normative E-P relationship (the regression residual) can be used to calculate that subject's current mental health reactivity to stressor exposure ("stressor reactivity," SR). The SR score takes into account the individual extent of experienced adversity and is comparable between and within subjects. Individual SR time courses across monitoring time points reflect intra-individual temporal variability in SR, where periods of under-reactivity (negative SR score) are associated with accumulation of fewer mental health problems than is normal for the sample. If FRESHMO is accompanied by regular measurement of potential resilience factors, temporal changes in resilience factors can be used to predict SR time courses. An increase in a resilience factor measurement explaining a lagged decrease in SR can then be considered to index a process of adaptation to stressor exposure that promotes a resilient outcome (an allostatic resilience process). This design principle allows resilience research to move beyond merely determining baseline predictors of resilience outcomes, which cannot inform about how individuals successfully adjust and adapt when confronted with adversity. Hence, FRESHMO plus regular resilience factor monitoring incorporates a dynamic-systems perspective into resilience research.

Keywords: adaptation; adversity; allostasis; coping; dynamic system; homeostasis; mental health; stress.

Publication types

Review