Psychiatric Annals

CME 

Mindfulness Meditation for Increasing Resilience in College Students

Holly B. Rogers, MD

Abstract

CME Educational Objectives

1. Discuss the interplay between stress and resilience.

2. Describe the unique characteristics of emerging adulthood.

3. Describe the beneficial effect of mindfulness training on resilience.

Resilience, the ability to recover psychologically from stressful or traumatic events, is often discussed in the psychiatric literature in terms of an individual’s ability to recover from significant trauma. Much of the information about what builds or inhibits an individual’s resilience is based on research on people who have survived severe traumas or on animal models of severe trauma. However, in the world of college counseling, the emphasis is slightly different. Although there are certainly a number of college students presenting to student counseling centers who have survived horrific challenges, a much more common presentation is the student who is having trouble adapting to more-routine life events, such as failing in academic endeavors or being rejected by a love interest. Helping emerging adults (EAs) build the resilience they need to manage their day-to-day stresses is one of the core challenges for clinicians working with college students.

Abstract

CME Educational Objectives

1. Discuss the interplay between stress and resilience.

2. Describe the unique characteristics of emerging adulthood.

3. Describe the beneficial effect of mindfulness training on resilience.

Resilience, the ability to recover psychologically from stressful or traumatic events, is often discussed in the psychiatric literature in terms of an individual’s ability to recover from significant trauma. Much of the information about what builds or inhibits an individual’s resilience is based on research on people who have survived severe traumas or on animal models of severe trauma. However, in the world of college counseling, the emphasis is slightly different. Although there are certainly a number of college students presenting to student counseling centers who have survived horrific challenges, a much more common presentation is the student who is having trouble adapting to more-routine life events, such as failing in academic endeavors or being rejected by a love interest. Helping emerging adults (EAs) build the resilience they need to manage their day-to-day stresses is one of the core challenges for clinicians working with college students.

Resilience, the ability to recover psychologically from stressful or traumatic events, is often discussed in the psychiatric literature in terms of an individual’s ability to recover from significant trauma. Much of the information about what builds or inhibits an individual’s resilience is based on research on people who have survived severe traumas or on animal models of severe trauma. However, in the world of college counseling, the emphasis is slightly different. Although there are certainly a number of college students presenting to student counseling centers who have survived horrific challenges, a much more common presentation is the student who is having trouble adapting to more-routine life events, such as failing in academic endeavors or being rejected by a love interest. Helping emerging adults (EAs) build the resilience they need to manage their day-to-day stresses is one of the core challenges for clinicians working with college students.

Defining the ‘Emerging Adult’

The stage of life between the ages of 18 and 29 has come to be known as “emerging adulthood.” Arnett1,2 coined the term “emerging adult” and identified the characteristics of the age group, arguing that emerging adulthood constitutes a unique developmental stage. Dr. Arnett observed that in modern Western cultures, the developmental imperatives of adulthood, such as choosing a life partner, having children, and beginning a career, are being delayed until later in life. Young people in their 20s no longer live within the constraints of adolescence, living at home and following the rules of parents or other caregivers. At the same time, they are not yet taking on all the responsibilities of adulthood. What has emerged is an extended period of development that is largely taken up with personal growth and identity development. This pattern of adult development seems to cross racial and ethnic lines but may be somewhat limited by socioeconomic factors, with the poorest EAs often not having the same experience of delaying adult responsibilities.

Arnett articulated several characteristics of EAs, including an emphasis on identity exploration associated with instability and frequent changes in many spheres of life. EAs recognize they are making choices that will influence their future success and happiness, and they can feel intense pressure and worry about every decision. This time of growth and identity development is a period of excitement and change. Unfortunately, for many EAs, this is also a time of great strain and stress. One’s level of resilience can play a large role in how well she or he navigates challenges and inevitable failures along the way. Resilience can make the difference between flourishing or languishing during this critical time in development.

Stress and Resilience

The focus on resilience as a key aspect of mental health is relatively new. As the pendulum has swung away from an emphasis on what causes mental illness toward focusing instead on what constitutes mental health, it has become increasingly clear that resilience is a key component of mental health. Not surprisingly, there is a very broad spectrum of levels of resilience within the population. Some individuals suffer severe traumas, recover fairly quickly, and go on to develop levels of mental health that surpass their pretraumatic levels. Others show a consistent decline in their mental health after a trauma, never returning to their pretrauma baseline.3 Between these extremes exists a variety of responses reflecting varying levels of disturbance after a trauma and varying rates of recovery from the disturbance.

Interestingly, exposure to stress or trauma does not necessarily impair resilience. Whereas severe childhood trauma is associated with lower levels of mental health and resilience, stress at lower levels can act to increases one’s resilience. For example, animal studies show that extended maternal separation is a reliable strategy for producing rat-pups that are very stress-sensitive. However, brief maternal separation of about 15 minutes seems to be protective against stress. Rat-pups exposed to brief maternal separation are actually more resilient than non-separated offspring; behaviorally, they are less anxious and their cortisol levels return to baseline levels more quickly after a stressful event.4

Seery and colleagues5 found a similar pattern in humans. Using a multi-year longitudinal study, they found that individuals who had experienced a moderate amount of stress (six to 12 lifetime negative events) had better mental health and well-being than people who had faced high levels of adversity, but also better mental health than people who reported no history of adversity.

This finding in particular — that moderate amounts of adversity and stress actually improve resilience — is relevant to the presentation of patients at student counseling centers. Anecdotally, it seems that students who have been protected from adversity and loss throughout their childhood and adolescence are less prepared for the inevitable failures that are a normal part of emerging adulthood and the college experience. Students who have faced challenges in the past seem more likely to trust that they can recover when they encounter painful emotional experiences. For example, a young woman who had faced painful losses as a result of her parents’ bitter divorce presented to the counseling center at Duke after another painful loss, the death of a close friend in a motor vehicle accident. Despite feeling great distress over this loss, she held the conviction that in time she would recover. She stated, “I know I can get over anything,” and related this belief to her experience of having recovered during adolescence from experiences that were very hard for her. This well-internalized belief in her ability to make it through rough times added tremendously to her resilience in young adulthood.

Biological and Environmental Factors

Research on the neurobiology of resilience reveals that nature and nurture both make contributions. A portion of resilience is innate and biologically determined, but life experience and other environmental factors seem to play an equally strong role. There are clear genetically determined sensitivities to stress; however, the expression of these sensitivities is greatly influenced by environmental factors such as the quality of early parenting and, as noted above, the number and intensity of adverse events one experiences.

One of the best examples of the interplay between genetics and environment on the expression of resilience comes from Meaney and colleagues’6,7 work with rats. Their findings demonstrated that the rat-pups of high-nurturing mothers grew up to be less anxious and more resistant to stress than the pups of low-nurturing mothers. The biological correlates to this behavior include attenuated corticosterone secretion in response to stress and increased numbers of glucocorticoid receptors in the hippocampus in adult rats who were offspring of high-nurturing mothers. Importantly, however, if pups of a low-nurturing mother are adopted out and raised by a high-nurturing mother, the pups will develop the biological markers and behavioral phenotype of the biological offspring of the high-nurturing mothers. Thus, the early parenting environment strongly influences the expression of the genes that lead to greater resilience in adult rats. Similarly, secure early attachment is associated with higher levels of resilience in humans.8

The Amygdala’s Effects on Resilience

The neuroanatomical pathways and neurochemical factors involved in the modulation of the stress response are increasingly understood. Multiple neurochemical factors have been implicated in regulating the complex interplay between stress response and reward that mediates resilience.9 The brain regions involved include the prefrontal cortex, the amygdala, the hippocampus, the locus coeruleus, the nucleus accumbens, and the sensory cortex. A detailed analysis of these various components is beyond the scope of this article, but at least one neuroanatomical pathway is worth examining as it provides an avenue for intervention to enhance resilience: the pathway between the left prefrontal cortex (PFC) and the amygdala.

The amygdala is the gate-keeper of the stress response. Sometimes called the “fear center” because it generates and controls emotions related to fear and anxiety, the amygdala encodes the memories of fearful and anxious experiences. If their amygdala is removed, animals are unable to assess danger. Humans with a damaged amygdala have decreased experiences of anxiety and fear and cannot recognize fearful emotions in others.10 Individuals with post-traumatic stress disorder (PTSD) have been shown to have overly active amygdalae.11 Early trauma, known to reduce resilience, appears to cause sustained activation of the HPA axis, which sensitizes the amygdala and causes a heightened response to stress that becomes very difficult to modulate.

One aspect of resilience seems to be linked to the ability to attenuate the response of the amygdala to fear and stress. Davidson,10 a neuroscientist who has spent his career exploring the neurophysiological basis of emotion, hypothesizes that the left PFC plays a critical role in the modulation of the amygdala. Specifically, after reviewing data on asymmetrical affective influences of the PFC, Davidson suggested that the left PFC inhibits the duration of the amygdala’s response to stress. Activation of the left PFC appears to inhibit the stress response in the amygdala, shortening the amount of time it takes to recover from a traumatic stress. Thus, Davidson proposes that interventions that increase activation of the left PFC will diminish the stress response generated by the amygdala and reduce the time an individual needs to recover from a stress, therefore increasing resilience.

The left PFC, when activated, leads to increases in positive affect.12 These increases, perhaps through feedback on the amygdala, are associated with improved resilience. It may seem absurdly obvious that feeling good makes one less likely to feel bad, but there is a significant amount of science supporting this notion and identifying the biological factors at work here. Positive emotions undo or prevent the effects of stress.13 Enhancing one’s ability to experience positive emotions can act as a buffer against stress and the onset of depressive symptoms.14,15 All of this suggests that a therapeutic intervention focused on increasing the experience of positive emotions by enhancing activation of the left PFC can lead to improved levels of resilience. Fortunately, at least one intervention has been clearly shown to produce these desired effects: mindfulness meditation.

Benefits of Mindfulness Meditation

Mindfulness, the ability to focus one’s attention on his or her present-moment experience, releasing worries about the future and regrets about the past, has been shown to produce a host of benefits for both physical and mental health.16 The therapeutic benefits of mindfulness are an important component of multiple evidence-based psychotherapies, including Dialectical Behavior Therapy and Acceptance and Commitment Therapy. One specific benefit of mindfulness meditation is the augmenting effect it has on the experience of positive affect.17,18 Experienced meditators have been shown to have more positive emotions, and their experience of positive emotions is correlated with higher levels of left PFC activation relative to right PFC activation.16 This finding is true even in non-monk meditators. Davidson and colleagues19 were able to show that mindfulness meditation increased both the experience of positive emotions as well as activity in the left PFC after only 8 weeks of meditation training. Since increasing one’s experience of positive emotions confers increased resilience, it makes sense that engaging in a practice that increases positive affect will lead to improved resilience.

Multiple studies show that training in mindfulness is a useful intervention for college and graduate students.20,21 Unfortunately, there has been little attention paid to the best way to teach mindfulness to emerging adults who may be resistant to engaging in these types of practices.22 Students are often skeptical of mindfulness meditation and may worry it is too “new-agey” or “touch-feely.” An additional issue is that many students feel so pressed for time and overburdened by their commitments that it can be hard to convince them to devote the time needed to learn the skill of mindfulness. Programs designed specifically for EAs are needed, and one such program has been developed at Duke University.

The Duke program, called Koru, is a developmentally targeted model for teaching mindfulness and meditation to EAs. The model takes into account the developmental characteristics of the age group and has proven effective for engaging EAs in the practice of mindfulness.22 Koru, detailed in Mindfulness for the Next Generation, differs from other models for teaching mindfulness in several ways.22 First, it is very structured, with required attendance at four 75-minute classes and mandatory meditation homework between classes. Second, Koru emphasizes practices that directly target anxiety and stress, common concerns for students enrolling in the program. Third, Koru is taught in groups of about 12 students to optimize the positive effects of peer interactions. Fourth, the teaching actively works to address skepticism and build motivation. Finally, the language and metaphors used in the class are specifically chosen to be relevant and interesting to EAs.

Anecdotally, Koru has proved to be popular with students; groups fill rapidly, often with long waiting lists, and attendance is consistent. A randomized, controlled trial of Koru showed significant (P < .05) increases in mindfulness and self-compassion and significant decreases in perceived stress and sleep problems.23 Additionally, students who complete Koru training consistently report that they experience meaningful positive change as a result of their participation in the course.22 These outcomes are consistent with increases in positive affect and likely lead to greater resilience.

Conclusion

Resilience is a complex psychological phenomenon, influenced by both biological and environmental factors. For emerging adults, resilience may be particularly important, as their stage of development leads them to face new challenges for which they may not be fully prepared. The research on the neurobiology of stress and resilience shows that increasing one’s experience of positive affect is an effective means of enhancing resilience. Thus, mindfulness meditation, which has proven to increase positive affect, is a viable option for enhancing resilience in EAs. However, it can be challenging to engage this age group in the practice of mindfulness. Programs that are developmentally targeted to specifically address the needs and interests of emerging adults will likely have greater success engaging college students and helping them develop a meaningful degree of skill with mindfulness. As their ability to practice mindfulness and meditation grows, so should their resilience, and with that, their confidence in their ability to manage the complex challenges of emerging adulthood.

References

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Authors

Holly B. Rogers, MD, is Staff Psychiatrist, Counseling and Psychological Services, Duke University; Clinical Associate, Department of Psychiatry, Duke University Medical Center; and Director, The Koru Center for Mindfulness.

Address correspondence to: Holly B. Rogers, MD, Counseling and Psychological Services, Duke University, Box 90955, Durham, NC 27708; email: holly.rogers@duke.edu.

Disclosure: Dr. Rogers has ownership interests in The Koru Center for Mindfulness.

10.3928/00485713-20131206-06

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