Stress and Promoting Resilience in Children and Adolescents

What is Stress?

There are a variety of definitions for the word stress in the English language. Webster Mirriam defines stress (n) as:

1. Constraining force or influence such as:
   • force exerted when one body or body part presses on, pulls on, pushes against, or tends to compress or twist another body or body part
   • the deformation caused in a body by such a force
   • a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation
   • a state resulting from a stress
   • strain, pressure
2. Emphasis, weight
3. Intense effort or exertion
4. Intensity of utterance given to a speech sound, syllable, or word producing relative loudness
5. Relative force or prominence of sound in verse/ syllable having relative force or prominence.

Merriam-Webster. (n.d.). Stress. In Merriam-Webster.com dictionary. Retrieved March 30, 2023, from https://www.merriam-webster.com/dictionary/stress

Although many people use the term “stress” to refer to emotional factors, as noted in the definition above, stress can have many different facets.  In the context of the body, stress is experienced in both the physical and psychological sense, with a bidirectional relationship between these two “different” forms of stress.  There is a strong association between neuroinflammation and emotional stress (Frank et al., 2016) and many medical concerns and disorders are often exacerbated by emotional stress (e.g., exacerbation of skin disorders, cardiovascular disorders caused or precipitated by stress, initial presentation of epileptic seizure is most often precipitated by preceding early life stress) (Keynejad et al., 2019).  Thus, when supporting children and families in conversations regarding stress and promoting resilience, it is important to remember that all stressors (physical, emotional, immunological, hormonal, environmental) can be targets for strategies that promote resiliency.

Research has also highlighted that youth who suppress their emotional expression report higher levels of stress-related symptoms (Moore et al., 2008). In other words, the lack of emotional expression can also increase risk of stress, and should also be identified as a potential risk factor for poorer outcomes when other stressors occur.

Promoting Resilience

Resilience has been defined in the literature as positive adaptation in the face of adversity (Luthar et al., 2000) and has been described as the process by which an individual harnesses resources to sustain psychological or physical well-being in the face of stress (Rosenberg et al., 2019). Most importantly, resilience is a process—it can be promoted and it is not a fixed trait.  The domains listed below have been most closely associated with resilience among youth (Sapienza & Masten, 2011). Promoting resilience is recommended for all children and families, however bolstering resilience among youth who may be at greater risk of adverse life experiences may be particularly helpful for prevention of greater concerns down the road.

Resilience Domains	Potential activities or behaviors to promote resilience
Positive relationships and strong attachment with caring adults (parents and other adults)	Encourage teens and parents to spend quality time together lead by the child’s interests Encourage mentoring relationships with other safe adults like extended family, coaches, teachers, community leaders, etc.  Create a culture of open emotional expression so children and teens feel comfortable expressing emotions within the family context.  Use of consistently discipline, limits, and family expectations helps promote healthy attachment relationships.
Intelligence, problem solving, executive functioning skills and self regulation	Encourage activities and hobbies that promote problem solving; these activities will also likely promote building mastery and distress tolerance Embrace a culture of healthy emotional expression as a family, including sharing emotions regularly, and modeling coping with distressing emotions Positive responses from parents to a child’s emotions can support healthy emotional regulation skills
Perceived efficacy and perceived control	Encourage parents to provide opportunity for choice/forced choice.  Highlight and praise the effort and work that a child has put into specific activities (rather than focusing on the achievement only).
Motivation for achievement	Encourage youth to engage in activities that promote mastery that align with their interests (e.g., sports, art, video game development, etc).  Encourage children to approach difficult or potentially challenging activities.   Praising effort rather than achievement will reinforce a child’s desire to approach hard things, and gradually build their distress tolerance.
Positive relationships with peers and romantic partners	Encourage youth to engage in collaborative activities with peers and others promote positive relationships. Modeling healthy relationships also set the stage for healthy peer & romantic relationships for youth.
Faith, hope, spirituality and the belief that life has meaning	Encourage engagement in faith community, service activities within the community.  Encourage families to highlight layers of a child’s positive impact (e.g., connect their interests or hobbies with larger meaning for the community).
Effective teachers and school environment	Encourage children & teens to get to know their teachers.  Encourage parents to be aware or involved in school activities when possible.

Emotional reactivity is another child trait that may allow for greater resilience, as there is data to suggest that children with lower emotional reactivity may typically evoke more positive responses from caregivers in the context of emotional expression  (Eisenberg, 1994; Silk et al., 2007).  In other words, the less reactive to emotion a child is, the more positively parents may respond. Thus, supporting children with developing healthy emotional reactivity will be protective in the future.

Parent resilience is also important to promote as many of the same stressors that affect children impact the whole family system.  Similar to strategies for youth, intervention targets for parent resilience focus on coping with stress, setting concrete goals, challenging unhelpful or inaccurate thoughts, and engaging in making meaning from difficult situations (Rosenberg et al., 2019). Modeling parental self-care and emotion regulation is another key strategy for promoting resilience among youth.

References

• Eisenberg, N. (1994). Mothers’ reactions to children’s negative emotions: Relations to children’s temperament and anger behavior. Merrill–Palmer Quarterly, 40, 138–156.
• Frank, M. G., Weber, M. D., Watkins, L. R., & Maier, S. F. (2016). Stress-induced neuroinflammatory priming: A liability factor in the etiology of psychiatric disorders. Neurobiology of Stress, 4, 62–70. https://doi.org/10.1016/j.ynstr.2015.12.004
• Keynejad, R. C., Frodl, T., Kanaan, R., Pariante, C., Reuber, M., & Nicholson, T. R. (2019). Stress and functional neurological disorders: Mechanistic insights. Journal of Neurology, Neurosurgery and Psychiatry, 90(7), 813–821. https://doi.org/10.1136/jnnp-2018-318297
• Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543–562. https://doi.org/10.1111/1467-8624.00164
• Moore, S. A., Zoellner, L. A., & Mollenholt, N. (2008). Are expressive suppression and cognitive reappraisal associated with stress-related symptoms? Behaviour Research and Therapy, 46(9), 993–1000. https://doi.org/10.1016/j.brat.2008.05.001
• Rosenberg, A. R., Bradford, M. C., Junkins, C. C., Taylor, M., Zhou, C., Sherr, N., Kross, E., Curtis, J. R., & Yi-Frazier, J. P. (2019). Effect of the Promoting Resilience in Stress Management Intervention for Parents of Children With Cancer (PRISM-P): A Randomized Clinical Trial. JAMA Network Open, 2(9), e1911578. https://doi.org/10.1001/jamanetworkopen.2019.11578
• Sapienza, J. K., & Masten, A. S. (2011). Understanding and promoting resilience in children and youth. Current Opinion in Psychiatry, 24(4), 267–273.
• Silk, J. S., Vanderbilt-Adriance, E., Shaw, D. S., Forbes, E. E., Whalen, D. J., Ryan, N. D., & Dahl, R. E. (2007). Resilience among children and adolescents at risk for depression: Mediation and moderation across social and neurobiological contexts. Development and Psychopathology, 19(3), 841–865. https://doi.org/10.1017/S0954579407000417