Strategies to increase resilience — and wellbeing

A meaningful and enjoyable life and self-satisfaction—that is, restoration of positive affect and improved well-being—are the most important outcomes of treatment for people with major depressive disorder (MDD).1

Resilience,2 the successful adaptation and swift recovery from life adversities, is closely associated with improved well-being.3,4

Improved well-being is the top priority for patients with MDD

Adverse childhood experiences (ACE) are common and linked to the adult onset of a variety of diseases and social and emotional problems, including MDD.5 In the context of MDD, resilience refers to the net effects of psychosocial and biological intrinsic and extrinsic factors that:

  • decrease risk of onset or relapse
  • decrease illness severity
  • increase probability or speed of recovery6


Social, biological and cognitive factors promote resilience

Resilience improves well-being and outcomes for people with MDD5,7

Asking for help, developing trusting relationships, forming a positive attitude, and listening to feelings are factors that promote resilience. They not only help people improve their lives,5

Social influences, biological systems and cognitive processes link the neurobiological and psychosocial factors implicated in resilience.7

Social influence is the giving and receiving of social support:

  • giving support reduces physiological responses to stress and increases activity in reward processing regions of the brain
  • receiving support provides security and safety through the activation of cortical regions that potentially inhibit the sympathetic nervous system and inflammatory processes7

Biological systems influencing resilience include the HPA axis, neuropeptides, and neurotrophic factors in response to stress.7 Resilience-enhancing activities and strategies can protect against dysregulation of these systems.7

Enhanced cognitive abilities are the most efficient means of overcoming adversity7

Cognitive reappraisal is the ability to monitor and assess thoughts and replace negative thoughts with positive thoughts and so regulate one’s emotions:7

  • positive reappraisal is a significant predictor of adolescent-perceived resilience7
  • children who are better able to regulate emotion through cognitive reappraisal exhibit greater resilience to MDD following childhood trauma8

Executive functions such as attention, problem-solving and decision-making as well as learning and memory are enhanced by some types of adversity and contribute to greater resilience.7

A higher full-scale intelligence quotient, which is a broad intelligence scale that includes measures of cognitive efficiency,9 independently predicts resilience.10


Strategies to increase resilience

Intrinsic factors may not be sufficient to withstand severe adversity

Intrinsic genetic and personality factors are thought to be sufficient for individuals to respond effectively to low-intensity or short-duration adversity but may not be sufficient to withstand moderate to severe adversity.

Strategies to increase resilience may be needed in these situations. Such strategies target the neural systems involved in emotion and stress regulation, cognitive processes and social behaviors and include:

  • social support
  • ensuring adequate sleep, nutrition and physical activity
  • cognitive training techniques
  • pharmacological therapy9

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.


  1. Demyttenaere K, et al. J Affect Disord 2015;174:390–6.
  2. Gao T, et al. Int J Nurs Pract 2017;23:e12535.
  3. Rutten BPF, et al. Acta Psychiatr Scand 2013:128:3–20.
  4. Angeler DG, et al. Int J Bipolar Disord 2018;6:2.
  5. Got your ACE score? Accessed 14 May 2020.
  6. Laird KT, et al. Transl Psychiatry 2019;9:88.
  7. Malhi GS, et al. Transl Psychiatry 2019;9(1):316.
  8. Rodman AM, et al. Biol Psychiatry 2019;86:464–73.
  9. Koriakin TA, et al. Dev Med Child Neurol 2013;55(9):840–5.
  10. Topiwala A, et al. PLoS One 2019;14(2):e0211273.