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Psychresilience: Inborn and Learned
By William Mace, PhD

The Centers for Disease Control and Prevention released a report in 2011 indicating that, during the previous year, 25% of adult Americans reported having a mental illness. The report also indicated that about 50% of adult Americans will experience mental health challenges at some point in their lives.

But why won’t the other half of adult Americans have a mental illness, even though they may be exposed to similar circumstances as those who do experience them? Is there an inborn way of thinking, an attitude, or a self-referential process that enables some individuals to be better prepared for life’s inevitable disappointments and losses? If so, can it be learned?

While mental health has focused on short-term psychotherapy, supplemented by psychotropic drugs, prevention scarcely has been mentioned, particularly for depression and anxiety among young adults. The Substance Abuse and Mental Health Services Administration reported in 2012 that nearly 30% of 18- to 25-year-olds had experienced mental illness the previous year, with depression as the most common condition.

Barriers to Accessing Mental Health Services
Social stigma is the major barrier to accessing mental health services: worrying what others may think about seeking mental health services; diagnostic labels, which can compromise a person’s sense of dignity at home, in the community and, if known, in the workplace; and hearing negative opinions from those who ultimately discontinue therapy and others who are dissatisfied with their psychotherapy.

The medical model of mental health is based on diagnostic categories, which in turn are based on symptoms. The categories often lack validity due to the overlapping of symptoms, they also are unreliable because of poor interrater agreement (the degree of agreement among raters).

Cognitive behavioral therapy (CBT) is the current gold standard for addressing self-defeating negative emotions. CBT successfully helps clients contain negative cognitions, or sustained, inaccurate, and often negative thoughts about the self. These are believed to cause depression rather than being generated by it.

The measure of success for CBT is the reduction of self-reported symptoms—eliminating the symptoms and, consequently, the depression. The problem is that reducing symptoms requires the deliberate and ongoing suppression of these symptoms out of our immediate awareness, yet continue to influence our moods and behaviors, as evidenced by a lack of spontaneous joy and a flat affect.   

What has been missing is a reformulation of the medical mental health model, with its emphasis on diagnostic categories, to an educational mental health model, emphasizing a self-empowering learning approach. Self-empowerment in this instance means someone making choices based on self-interest as long as the individual is willing to accept the consequences—in short, taking personal responsibility, particularly for unresolved anger, whether or not it’s justified.

Unresolved anger gives rise to anxiety, depression, and a multitude of self-defeating behaviors. It takes excessive psychic energy to suppress unresolved anger for fear of inappropriately expressing it. It also leads to a lack of psychological resilience when things go awry.

Educational Mental Health Model
PsychResilience Training (PRT) is a short-term learning approach for the prevention and treatment of depression and anxiety. It’s based on psychological resilience as a self-referential process that can be learned to maintain a positive sense of self under prolonged stress.

The distinguishing feature of PRT is that it becomes self-generating after the initial training. It provides insight into debilitating anxieties and dysfunctional behaviors, enabling the client to address core issues head-on. Long-standing unresolved anger and anxieties are seen from an empowered, positive sense of self. The energy previously spent on containing anger now becomes energy available for positive pursuits.

PRT Postulates
Our rational mind has two voices: our own voice and the voice of authority figures embedded in our minds from childhood (e.g., “You must look before crossing the street.” “You needto follow directions.” “You have to do your homework.”) This embedded voice often is mistaken for our own voice but is recognizable when we tell ourselves “I have to do this,” “I need to do that,” or “I must do the other.” These have-tos always are mandatory, without choice.

These early taught have-tos soon become habit of mind, controlling our emotional life with either-or value judgments: good or bad, right or wrong, moral or immoral. We begin to screen out our honest emotions not just to hide them from others but also to hide them from ourselves. We become anxious about inadvertently revealing our true feelings. Suppressing this anxiety leads to dysphoria and depression.

We can recognize our own voice by its use of want-tos, like-tos, and wish-tos. Want-tos provide the freedom to change our minds. They don’t necessarily dispel all have-tos as without merit, since our own voice can independently determine merit based on our own self-interest. Want-tos place us in charge of our lives.

Those who refuse to let go of have-tos must default to embedded or outside authority to make decisions for them. Submitting to authority, however, can lead to powerlessness, anxiety, and depression. It’s difficult to feel good about yourself when someone else is pulling the strings, and you’re only reacting.

How do we change have-tos to want-tos? “I have to study to get good grades” can become “I want to study because I want good grades.” And “I have to exercise to stay healthy” can become “I want to exercise because I want to stay healthy.”

Owning Up to Anger
Almost everyone carries suppressed anger. The problem with suppressed anger is that, periodically and often unexpectedly, the lid blows off and uncontrollable rage surfaces. In spite of our rational will, the power of our angry feelings temporarily takes control.

Our rage may be out of proportion to the immediate situation yet, along with this rage, we may momentarily experience a sense of personal liberation and exhilaration. This explosive power, of course, reflects our animal side. It’s like a Bengal tiger pouncing out of a cage, with its massive paws; orange fur with black stripes; and long, arched tail. Nearly everyone carries a tiger inside. It’s the part that has all the anger yet also has all the fun.

Our tiger represents our honest emotions minus any restraints. We want to liberate our honest feelings to take charge of our lives. Yet it’s important to not just release our tiger and allow him or her to run wild; limits must be set. The tiger won’t listen to the embedded voice of authority inside our heads, much less to the voice of authority outside of our heads. The embedded voice of authority and the tiger have been at odds all of our lives; the two are incompatible and frequently in conflict, which manifests itself in periods of depression, anxiety, and low self-esteem.

Our own voice can be just as rational as the embedded voice of authority but not limited to either-or choices. Our tiger exemplifies fun, a love of life, and humanity but can’t communicate or behave rationally. When we connect the vitality of our tiger with the rational power of our own voice, nothing can stop us from finding solutions to our problems and being the best we can be.

A New Paradigm
PRT acknowledges social deviance theory, which holds that society is irrational, with anxiety and depression the result of a growing conflict with individual rationality. PRT acknowledges the anthropological view that young people are socialized to adopt values and norms that are dysfunctional for them as adults. It also acknowledges psychodynamic theory, with its emphasis on validating the tiger (anger) and strengthening one’s own voice vis-à-vis the embedded voice of authority.

According to a February 3 USA Today account, Health and Human Services Secretary Kathleen Sebelius reports an estimated 60% of adults experiencing a mental health condition don’t seek professional help. Stigma poses the greatest barrier, thwarting public mental health efforts to promote early treatment and prevent worsening of symptoms over time. Promoting public mental health, however, depends on more than just removing the shame barrier. It also depends on a self-empowering learning approach and, most importantly, creating an effective delivery system, without which we go nowhere.

PRT opens a new, comprehensive approach to mental disorders by applying techniques from other academic disciplines. It recognizes intrapersonal conflict as a primary cause of anxiety and depression, and promotes personal responsibility by emphasizing proactive decision making. With the support of those in the helping professions, PRT can provide greater outreach and a more effective delivery system for public mental health.

— William Mace, PhD, is a clinical psychologist in private practice.