Coping Models of Stress and Resilience

This chapter provides a review of research on the role of processes of coping as a source of resilience to the adverse effects of stress in childhood, adolescence, and adulthood. Advances in research on models of coping that distinguish responses based on stressor controllability are emphasized. Important similarities between models of coping and emotion regulation are highlighted to encourage integration of research on these two topics. Findings from research on the association between coping and symptoms of psychopathology in adulthood, childhood, and adolescence are reviewed. Directions for future research, including the implications of research on coping for the development of preventive interventions and treatments, are highlighted.

Introduction

In this introductory chapter, we provide an overview of The Handbook of Stress and Mental Health. We begin by introducing the scope of the issue and critically operationally defining the construct of stress. We then provide a description of the chapters included in the volume, as well as an outline of the purpose of each of the five major sections: Assessment and Definitional Issues, Stress Exposure and Mental Health, Psychological Models, Neurobiological Models, and Stress Resilience and Treatment. The contributors represent international leaders in the field of stress and provide authoritative and integrative review and analysis of the evidence base in this crucial area of study.

The Temporal Elements of Psychological Resilience to Potential Trauma

Potential trauma is common across the life span. Responses to these highly aversive events vary significantly, yet many individuals will demonstrate psychological resilience and a clear pattern of psychological health and adaptive functioning in the wake of extreme adversity. Amid expanding conceptual diversity and a proliferation of research, we present a novel, unified framework for resilience that consists of four constituent, temporally related elements: baseline or preadversity functioning, the actual aversive circumstances, postadversity resilient outcomes, and predictors of resilient outcomes. The temporal framework integrates and extends several existing lines of research by conceptualizing resilience as a process that unfolds over time with each temporal element playing an essential role.

Stress and Mental Health: Epilogue

In this epilogue, the editors of this volume provide a synthesis of the preceding chapters. In addition to highlighting the current state of the scientific literature, future directions for the rapidly evolving field of stress and mental health are outlined, with an emphasis on key issues surrounding the development of new methods and levels of analysis, improvements in assessment approaches, and how training and collaboration can evolve toward the goal of facilitating new insights. Prominent conceptual issues requiring consideration and clarification are discussed, with a particular focus on the fundamental principles that underlie models of stress and mental health, as well as resilience.

Psychophysiological Models of Stress

Psychophysiological models have a long history within stress research of trying to explain the link between stress exposure and psychological and physiological disease. The current chapter tries to offer complementary perspectives on this issue. First, it covers the relevant physiological systems (sympathetic, parasympathetic, enteric nervous system) and their markers (heart rate, heart rate variability, blood pressure), such that the reader receives an overview of the significant factors at play. Second, it provides an overview of the various forms of stress (acute, chronic, and stress during early life periods) that are believed to put the individual at heightened risk to develop stress-related disease. Finally, it presents the theories and models that have emerged over the years that try to explain how the various forms of stress can eventually lead to psychological and physical disease. The chapter ends with a short outlook on some recent work emphasizing the interaction between the various systems at play, and how that by itself can play a role in the origin of stress-related disease.

Genetic and Epigenetic Models

Both genetic variation and environmental exposures play key roles in the development of mental health or psychopathology. Their roles are interdependent: The effects of genetic variants depend on environment, and the impact of environment depends on the genetic variants. This chapter will explain and critically review the most important models of gene–environment interplay, including gene–environment correlation, gene–environment interaction, and epigenetics. Gene–environment correlation describes a mechanism where genetic variants influence the likelihood of environmental exposure. Gene–environment interactions refer to a mechanism where genetic variants influence the impact of an environmental exposure on the individual. Finally, epigenetics provides a molecular mechanism through which environmental exposures affect the function of genes for long periods of time. The chapter concludes with a discussion of the limits of current knowledge, its implications for treatment and prevention, and directions for further research.

Novel Pharmacotherapeutics for Stress-Related Disorders

Most mental health problems associated with psychological distress originate with activation of centrally regulated stress pathways, yet a diverse range of central nervous system and somatic disease states can be influenced by exposure to severe or unrelenting stress. The goal of this chapter is to provide a conceptual framework to guide the development of pharmacological intervention strategies. We propose that careful consideration of the relationship between the timing of stressful life experiences, pharmacological intervention, and the ultimate expression of disease symptomatology is critical for the development of pharmacological interventions to treat stress-related disorders. We review a range of physiological systems that are known to be activated by stress, offering potentially new targets for drug development efforts, and argue that participant selection is a key predictor of drug efficacy trials. In doing so, we point toward inflammatory signaling pathways as a potential final common mediator of multiple stress-related disease states.

Stress in Schizophrenia

This chapter contains a review and discussion of evidence linking various types of psychosocial stress with the onset and course of schizophrenia and other psychotic disorders. Stress has long been considered an important factor in the etiology of psychosis and psychotic disorders. Specifically, stress is thought to interact with pre-existing biological vulnerabilities to trigger psychosis through complex changes to various biological processes (e.g., changes to HPA axis, neurotransmitter activity, and inflammatory processes). This chapter includes discussion of a wide variety of stress experiences, including daily hassles, life events, trauma, childhood adversity, and minority stress, and explores the scientific evidence linking these stressors with psychosis and psychotic disorders. Biological processes and biomarkers associated with both stress and psychosis are also discussed. Finally, important questions relating to the future study of stress and psychosis are considered.

Alcohol Dependence Conceptualized as a Stress Disorder

Alcohol use disorder is a chronically relapsing disorder that involves (1) compulsivity to seek and take alcohol, (2) difficulty in limiting alcohol intake, and (3) emergence of a negative emotional state (e.g., dysphoria, anxiety, irritability) in the absence of alcohol. Alcohol addiction encompasses a three-stage cycle that becomes more intense as alcohol use progresses: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. These stages engage neuroadaptations in brain circuits that involve the basal ganglia (reward hypofunction), extended amygdala (stress sensitization), and prefrontal cortex (executive function disorder). This chapter discusses key neuroadaptations in the hypothalamic and extrahypothalamic stress systems and the critical role of glucocorticoid receptors. These neuroadaptations contribute to negative emotional states that powerfully drive compulsive alcohol drinking and seeking. These changes in association with a disruption of prefrontal cortex function that lead to cognitive deficits and poor decision making contribute to the chronic relapsing nature of alcohol dependence.

Stress and Personality Disorders

This chapter reviews literature investigating the complex relationships between stress and personality disorders. Various forms of early life adversity, particularly experiences of abuse and neglect, portend the development of personality disorders and maladaptive personality traits later in life. Much of this association appears to be causal (i.e., independent of genetic risk). A comparatively much smaller literature suggests that acute stressful events later in development show complex interrelations with personality disorders. These connections appear to be bidirectional, such that not only does stress influence the development of personality, but personality also influences stress exposure. Additionally, personality traits influence the way in which individuals respond to stressors, both psychologically and physiologically. Our review concludes by underlining enduring methodological problems and conceptual issues that await resolution in future empirical work.