Resilience Pathways in Psychosis

Risk factors for psychosis spectrum disorders have been studied for many years, but recent research has begun to focus on resilience factors that protect against illness onset and mitigate illness course. Understanding resilience pathways will help us to apply interventions that can prevent psychosis and/or significantly improve illness trajectory.

Recent studies emphasize two complementary approaches for identifying resilience pathways: (1) At the population genetics level-by examining how the effect of psychosis risk genes may be counterbalanced by genetically determined resilience factors with identifiable mechanisms of action; and (2) At the individual trajectory level-by determining what protects against transitioning into psychosis for high-risk individuals or against worse outcomes for those with established illness.

Findings from distinctly different research approaches converge on the brain's neurocognitive, social cognitive, and metacognitive capacities as key resilience factors for psychosis spectrum disorders.

Neurocognitive, social cognitive, and metacognitive capacities-as experienced within an individual's social context-can buffer the effects of stress exposure on vulnerable individuals by enabling adaptive behavioral strategies and modulating maladaptive neurophysiologic responses. Resilience-promoting interventions that target these factors include: fostering safe and supportive social contexts for individuals at risk for or experiencing psychosis; developing their cognitive health knowledge and interpersonal skills; applying scalable interventions to improve cognition and social cognition; and offering resilience training focused on metacognitive strategies.