The Cultivation of Psychological Resilience as an Older Adult’s Superpower

Abstract:

Psychological resilience is vital to the well-being of older adults. A resilience framework acknowledges that challenges exist but emphasizes strengths. Resilience, a multidimensional construct, is influenced by the interaction of internal factors and external resources. Older adults are capable of sustained resilience. To regain one’s sense of self when faced with adversity requires building on personal strengths and using psychotherapeutic strategies. This article focuses on the dimensions and underlying factors of psychological resilience in older adults, and tools that can be used when working therapeutically to cultivate resiliency as a catalyst for positive change.

Key Words:

psychological resilience, mental health

“At the heart of resilience is a belief in oneself—yet also a belief in something larger than oneself. Resilient people do not let adversity define them. They find resilience by moving towards a goal beyond themselves, transcending pain, and grief by perceiving bad times as a temporary state of affairs. Experts argue among themselves about how much of resilience is genetic. People seem to differ in their inborn ability to handle life’s stresses. But resilience can also be cultivated. It’s possible to strengthen your inner self and your belief in yourself, to define yourself as capable and competent. It's possible to fortify your psyche. It's possible to develop a sense of mastery” (Estroff Marano, 2003, para. 2–4).

Resilience is a complex, constantly evolving, dynamic, and multidimensional construct, which has broad implications for one’s capacity to adapt. The American Psychological Association (APA; 2022) defines resilience as “The process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands” (para 1).

In Zautra et al.’s (2010) definition of resilience, the focus is on resilience as an outcome and an adaptation when confronted with adversity. What these and other definitions of resilience have in common is that resilience helps restore balance while simultaneously serving as a protective factor and an inner strength when one experiences adversity.

Resilience is not a single skill, but rather a variety of skills and coping mechanisms. Resilience comes in many forms—psychological (the focus of this article), social, and physical. Psychological resilience is linked to psychological recovery from stressful, adverse, or traumatic life events (these terms will be used interchangeably throughout this article).

Laird et al. (2019) highlights the importance of a framework for understanding the construct of resilience. Theoretical perspectives conceptualize resilience in one of three ways:

1. Resilience is considered an attribute or trait, a stable resource upon which people can draw (Abramson & Braverman Schmidt, 2018). Each individual possesses this trait to varying degrees and these differences often predict how quickly one recovers from stressful situations.
2. Resilience also is considered to be a state or a dynamic process, whereby the adverse event or stressor provides an opportunity for the older adult to re-evaluate and consequently have the chance to change their behavior.
3. The third framework focuses on resilience as an adaptation to stress, trauma, or other adversities that one might encounter. Each perspective provides a context for clinical interventions based on reaction, capacity, and severity.

Psychobiological Components Impacting Resilience

When adversity is characterized as a hardship it can induce stress, but also it can be a catalyst to creating resilience (Fletcher & Sarkar, 2013). Psychological resilience is influenced by the interaction of both internal factors (i.e., personality, genetics) and external resources (i.e., social circumstances, environment; Linkov & Galaitsi, 2021). It is the interrelationship between genetic, neurobiological, cognitive, and developmental factors that influence one’s ability to cope and thrive in the face of adverse circumstances. Significant psychobiological factors that impact the potential for resilience include genetic factors attributed to resilience-related traits (such as emotional regulation, stress response, and the capacity to handle challenges). There is increasing evidence that genetics, dysregulated immune systems, insulin resistance, and changes in metabolism contribute to resiliency (Merchant et al., 2022).

Experiencing a traumatic event affects the brain circuity associated with focusing, flexibility, and emotional regulation. When one experiences continual trauma, feelings of danger and helplessness cause the body to secrete stress hormones, which negatively impact the body’s immune system and organ functioning (van der Kolk, 2014).

Neurotransmitters such as dopamine and serotonin influence mood and regulation of the stress response. Other brain regions—the medial prefrontal cortex, anterior cingulate cortex, thalamus, hypothalamus, amygdala, and hippocampus—are involved with resilience (Miyagi et al., 2020). A major function of the prefrontal cortex (considered to be the administrator in charge of resilience) is response flexibility (Siegel, 2007). The process of coping with life stressors increases prefrontal myelination and expands a region of cortex that broadly controls arousal regulation and resilience. Psychological resilience may have neuroprotective properties (Laird et al., 2019), wherein the brain rewires itself to heal and to restore—thus enhancing resilience.

Early childhood experiences (nurturance, attachment, and relationships) combined with environmental conditions significantly impact an individual’s psychobiological capacity for resilience. The impact of early experiences with hardships and the social environment arising from the intersectionality of systemic racism, poverty, or adverse childhood experiences may further impact a person’s health and ability to bounce back as they age.

Generational or intergenerational trauma also has the capacity to affect older adults’ physical health by activating the stress response and decreasing the capacity to cope under pressure. These traumas can result in increased inflammation, cardiovascular problems, and compromised immune function. Existing health conditions also may worsen or become more challenging to manage. All of these psychobiological factors play a significant role in resilience, influencing the capacity to effectively respond to life’s stressors.

Psychosocial Components and Personality Characteristics Impacting Resilience

The combination of having a strong psychosocial adaptive system combined with an individual’s biological stress-regulation, immune system, problem-solving skills, and personality characteristics can be protective and can be activated when facing a traumatic event (Masten, 2021). Previous experience with trauma or adverse events causes significant psychosocial challenges and highlights the older adults’ coping skills or lack thereof. Severity of the trauma, accumulated life experiences, and age-related vulnerabilities are additional psychosocial components impacting resilience. Also, internalized attitudes about aging, negative stereotypes, and ageism negatively impact an older adult’s resilience.

Conversely, specific psychosocial factors have an ameliorative effect and have significant potential in influencing an older adult’s ability to thrive in the face of adversity. Social support, including strong connections with family, friends, and community can enhance resilience. Being visible, having a sense of belonging and validation from others helps to navigate stressful situations when they arise. These increased social connections, and leaning on one’s social networks, have been found to decrease depression and anxiety.

Simultaneously, these perceived connections increase the belief that friends and/or family will provide support when needed. Self-efficacy, a social-psychological construct, contributes to resilience as it provides one with the confidence to handle difficult situations. Belief systems that support one’s ability to handle stress, manage one’s emotions effectively, overcome challenges, and achieve desired goals are integrated into one’s narrative of being able to adapt to one’s circumstances (Folkman & Moskowitz, 2004).

By using a growth mindset, resilient individuals approach challenges, seek solutions, and take the time to assess circumstances when overcoming obstacles. Resilient individuals often look for strategies that help them improve and resolve the present situation (Vahidi, 2021). Cognitive factors such as cognitive flexibility and adaptive coping strategies impact individual thinking and belief systems, and influence the level of resilience in confronting challenges. Other social factors such as access to education, spiritual support, and financial stability increase resilience. Although exposure to trauma and adversity can be harmful, these challenges also can foster personal growth and wisdom because of the belief that good can result from experience. Highly resilient older adults exhibit both a faster physical and emotional recovery from stressors, supporting the importance of cultivating resilience when working with older adults.

Personality style and temperament are two protective factors that shape and modify the experiences of psychological and environmental stressors and adversity. Resilient individuals seem to possess qualities such as “grit” (perseverance and determination) and adaptability (Laird et al., 2019). Having an internal locus of control (sense of mastery) is another personality characteristic linked to how well an older adult adapts to adversities, the ways in which the individual views and engages with the world, their social supports and resources, and their past and present coping strategies (APA, 2022).

It appears that some people innately possess better responses to adversity and distress. The APA (2020) describes characteristics displayed by resilient individuals that include: 1) having strong relationships and social support networks, 2) being flexible with a willingness to adapt, 3) maintaining a positive outlook and optimism, 4) emotional self-regulation, 5) engaging in mindfulness and spirituality, 6) having strong problem-solving skills, 7) understanding and embracing one’s strengths, 8) demonstrating emotional awareness, and 9) finding a sense of meaning. These characteristics are at the basis of a strengths-based approach.

Cultivating Resilience in Clinical Practice

Resilience is an important pillar for optimal aging. As one works with clients it is important to keep in mind that resilience is a dynamic, constantly evolving trait. Resilience is learnable, trainable, and teachable as capacities for resilience are innate in the human brain. Psychological research on resilience indicates that the skills and resources linked to greater positive adaptation can be practiced by older adults. Cultivating resilience is at the heart of the therapeutic process.

As a clinician it is important to hold faith in the client’s potential to build resilience and share with the client that adversity provides an opportunity for learning more resilient behaviors. Mental health professionals can lead clients in learning new skills to help them cope more skillfully with the inevitable ups and downs of life in ways that are efficient and effective. Whatever the presenting issues—illness or injury, loss, or infidelity—trauma or whatever the presenting symptoms—anxiety, depression, shame, despair—clients come to psychotherapy for guidance and support in recovering and discovering their strengths, their competencies, and improving their well-being.

The process of cultivating resilience in older adult clients is highly individualized and may vary for each person, so the clinician will need to work with each individual to determine what is most important in building and restoring their balance. The first step in building resiliency with older clients begins with helping clients to “avoid seeing crises as insurmountable problems” (APA, 2022) and building on their existing strengths. Mental health professionals can build on an individual’s grit and promotive and protective factors.

Tools and Techniques to Supercharge Resilience

Supercharging resilience begins with a resilience-oriented treatment approach. Linkov and Galaitsi’s (2021) matrix incorporates four domains—physical, informational, cognitive, and social—that guide the clinician in assessing how the individual functioned in each domain both before and during the adverse event. This serves as a guide to coach clients in the adaptation process by focusing on existing internal strengths (Linkov & Galaitsi, 2021).

To ameliorate the impact of adversity, it is important to help the client identify appropriate support and resources, consider their life experiences, generational, and intergenerational influences, as well as current developmental changes. Culture and psychosocial factors such as loss of loved ones, retirement, or new living environments may have to be processed and integrated into the therapeutic process on the client’s road to building resilience. The therapist must be sensitive to any physical and medical limitations so the clients can do the work in the therapeutic session.

Empowering individuals with age-based, culturally and gender appropriate mental health services, trauma-informed interventions, and social support networks can help reduce the severity of trauma and increase the potential to recover. The more important recovery is to the person, the more likely they will remember the skills learned in the recovery process.

There are numerous tools and techniques that can be used with clients to cultivate resilience.

1. A strengths-based approach is predicated on the belief that each individual has the capacity to empower themselves with unique goals, inner strengths, and external resources. This approach uses techniques and strategies focused on channeling an individual’s existing inner strengths and resources to overcome adversity, emphasizing personal assets, skills, and positive qualities. By highlighting what individuals can do well and leveraging their existing skills and abilities, older adults will be better equipped to bounce back from challenges and setbacks.
    
2. Cognitive behavioral practices that support the cultivation of resilience such as Life Integration Therapy, based on the belief that there is an innate ability of the mind-body to heal itself, has various protocols including a “life review” timeline, integrating past traumas and unresolved issues that can be reframed, thereby creating choices of how to proceed in the present.
   
   Using the tenets of positive psychology, mental health professionals are encouraged to work with clients from the perspective that cognitive behavioral change is significant to enhance wellness. By deconstructing anxiety, thought patterns can improve the way one feels, thereby enhancing self-esteem and interrelationships with others. The cultivation of resilience can be viewed as a superpower in mental health. It helps develop grit through difficult times, increases self-confidence, helps rebound from adversity, and diffuses stress to enable personal flourishing. These are powerful benefits.
    
3. Mind-Body Practices, such as Tai Chi and yoga, address the common disconnection from the body to help the older adult become more present. Mind-body interventions increasingly are used to promote stress reduction and are associated with a range of positive outcomes including improved cognitive function and resilience. Benefits include pain and tension reduction, relaxation, healing, and improved coping skills, often in the face of shame or blame. Tai Chi and yoga are defined by slow, intentional movements as moving meditations that increase emotional regulation. Van der Kolk (2014) posits that body connection activities, such as yoga, Tai Chi, and breathwork, improve interoceptive awareness to effect positive psychological changes.
    
4. Mindfulness is defined as a moment-to-moment awareness of one’s experience. Mindfulness practice improves concentration and reduces negative rumination by retraining the individual to be aware of the present moment without judgment, causing the brain’s neurocircuitry to rewire. There are many practices that cultivate mindfulness such as Qigong, meditation, and yoga, and all of these practices involve training awareness on the present to increase capacities of clarity and calm.
   
   According to the National Institutes of Health (2021), mindfulness practices may help people manage stress, cope better with serious illness, and reduce anxiety and depression. Evidence suggests that mindfulness can lower blood pressure, improve sleep, and cope with pain. Many people who practice mindfulness report an increased ability to relax, a greater enthusiasm for life, and improved self-esteem, and the ability to decrease rumination. Practicing mindfulness builds resilience by helping the older adult more skillfully bring compassion to themselves.
   
   Within the practice of mindfulness is a specific meditative technique of Loving Kindness meditation. This practice of being aware of the present moment, expressing self-gratitude and kindness, and sending oneself intentional good wishes creates benevolence and wellness. It enhances positive emotions and empathy toward oneself, mitigating feelings of sadness. Ben-Shahar (2007) describes Loving-Kindness Meditation as effective for self-reproving individuals in reducing this behavior and depressive symptoms, as well as improving self-compassion and positive emotions. ‘Cultivating resilience is at the heart of the therapeutic process.’
    
5. Visualization and Affirmation are tools used in mental rehearsal that increase positivity. Visualization is a technique using mental imagery that can reprogram the nervous system to improve well-being. Body scan visualization is defined by focusing attention to parts of the body and bodily sensations in a gradual sequence from feet to head to reconnect with the physical self without judgment, leading to improved wellness. Affirmations are a form of self-talk that changes thought patterns and influences positive behavioral changes.
    
6. Resilience as a mindset. Mental health professionals guide older adults to interpret and respond to situations in a more positive way. Clients are redirected to see challenges as opportunities for personal growth through assessing their responses to stress and visualizing positive ways of responding.
    
7. Reframing the narrative as a therapeutic practice helps the older adult view a situation from another perspective, changing the narrative and increasing awareness of unhelpful thinking patterns. Reframing externalizes the problem to let one look at the situation in a more objective manner, thus allowing for a reinterpretation of the negative situation by adopting a positive perspective: “I am willing to change the way I look at a situation.” This allows someone to view adversity as a temporary situation and see that crises are surmountable: “I can get through this.”
    
8. Increasing self-awareness. Teaching clients to accurately perceive what is happening, helping them bring self-awareness to where stress is being held in the body, supporting self-acceptance, and self-compassion to their reactions helps them gain perspective and view adverse change as an opportunity.
    
9. Becoming a more flexible thinker requires an effort to stop generalizing by using words such as “always,” “never,” and “nothing ever works out.” The goal is to pinpoint what needs to be done and empower the client to approach the problem in a more dynamic manner. This helps the older adult deal with uncertainty, solve problems, and incorporate new approaches.
    
10. Practicing gratitude is another super-charged, power-boost tool. Gratitude is associated with increased happiness and induces more positive emotions, savoring good experiences, positively impacting health, decreasing the stress response, and aiding social connection.
     
11. Self-compassion. Applying Buddhist philosophy, self-compassion has three main components: a) self-kindness versus self-judgment, b) a sense of common humanity versus isolation, and c) mindfulness versus overidentification (Neff, 2011). Self-compassion allows one to engage in self-care and self-love, which are necessary when facing difficult life events (Neff, 2011). These components combine and mutually interact to create a self-compassionate frame of mind, resulting in decreasing negative rumination, fear of failure, and increasing the potential for self-forgiveness. On a related note, savoring the good increases appreciation and positive emotions.
     
12. Enhancing self-efficacy reflects confidence in one’s motivation to leverage control over circumstances and can inspire solutions about stressful events.
     
13. Optimism. By experiencing appreciation in life, optimism is increased because a more positive outlook brings comfort to the present time. The client learns how to optimize their strengths rather than negative self-perceptions. By highlighting what individuals can do well and leveraging their existing skills and abilities, older adults are better equipped to bounce back from challenges and setbacks.
     
14. Purpose and Meaning involves serving a purpose greater than oneself to help in the discovery of one’s own value and worth.

Conclusion

“Sweet are the uses of adversity which, like the toad, ugly and venomous, wears yet a precious jewel in his head” (William Shakespeare, 1623/2006).

Resilience is a dynamic trait that can be developed. People who are resilient allow themselves to be changed and transformed by the experience of adversity, learning to focus on their strengths. With therapeutic support, older adults can develop and strengthen their coping skills, emotional regulation, and reactivity. The ability to prepare for and adapt to uncertainty and emotional emergencies is a key factor in resiliency. Cultivating resilience can significantly contribute to an older adult’s ability to navigate stressors and adversity that arise.

Tobi A. Abramson, PhD, is a licensed psychologist and has worked to improve the mental health of older adults and their families for more than 30 years. Abramson is a fellow of The New York Academy of Medicine and the Gerontological Society of America. Previously she worked at New York Institute of Technology as a full-time member of the faculty and continues as an adjunct professor. She is past president of the Board of Directors of the National Center for Creative Aging; Elders Share the Arts; the New York State Psychological Association’s Division of Adult Development and Aging; and the State Society on Aging of New York. She co-chaired Nassau County’s Geriatric Mental Health Alliance and was a member of the Long-Term Care Council of Nassau County. Her long involvement in ASA includes serving as a member of the Board of Directors for several terms, on the Generations Editorial Advisory Board, as past chair of ASA’s Awards Committee, MHAN’s Leadership Council and Editorial Board, co-chair of ASA’s NYC regional group, and on the Governance and Strategic Planning Committees of ASA. She has received ASA’s Mental Health in Aging award. She may be contacted at tobiabramson@yahoo.com.

Pamela Braverman Schmidt, Med, LCSW, LMHC, chairs the Human Service Program at Bunker Hill Community College, Boston, MA. She has co-authored articles published in New York State Psychologist, The International Journal of the Arts in Society, Generations, Teaching for Our Times Quarterly Review, Journal of Aging, Humanities and the Arts, and the Southwest Journal on Aging. Braverman Schmidt served as director of Positive Aging Services for Jewish Family Service, in Salem, and developed the first corporate-sponsored intergenerational arts-based program for the Stride Rite Foundation in Cambridge, MA.

Photo credit: Shutterstock/ Dmytro Zinkevych

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