Harnessing resilience in patient treatment and long-term recovery: Psychosocial and neurobiological pathways to enhanced outcomes

Abstract

Resilience - the dynamic capacity to maintain or restore mental and physical health in the face of adversity - has been linked to improved treatment adherence, reduced psychological distress, and enhanced long-term recovery in patients confronting serious illnesses such as cancer. Psychosocial resources (e.g., social support, peer-led groups) and neurobiological mechanisms (e.g., Hypothalamic-Pituitary-Adrenal axis modulation, neural plasticity) interact to buffer the physiological and emotional impact of diagnosis and therapy. Interventions including cognitive-behavioural therapy, mindfulness-based stress reduction, and digitally delivered programs demonstrate moderate-to-large effect sizes (Hedges' g 0.33-1.45) in strengthening resilience and improving quality of life. However, inconsistent terminology, the absence of standardized, multidimensional assessment tools, and logistical challenges in implementation limit widespread adoption. We advocate for a unified resilience framework that integrates psychometric scales, biomarker assays, and real-time digital monitoring; the embedding of resilience-promoting strategies within multidisciplinary care pathways; and the alignment of policy support and reimbursement models to sustain these efforts. Longitudinal, multicenter trials and culturally sensitive adaptation will be essential to validate scalable models, ensuring that resilience becomes a fundamental pillar of compassionate, patient-centered care.

Key Words: Resilience; Psychosocial interventions; Neurobiological mechanisms; Treatment adherence; Quality of life; Digital health interventions; Multidisciplinary care

Core Tip: Targeted interventions combining psychosocial support with neurobiological strategies can enhance resilience, improving coping, adherence, and recovery in patients facing serious health challenges. Initiating these strategies early and sustaining them throughout treatment maximizes their benefits. Using psychometric scales, biomarkers, and digital monitoring offers a comprehensive view of adaptive capacity. Multidisciplinary teams - including oncology, palliative care, and allied health - deliver culturally tailored interventions. Establishing unified definitions, standardized measurements, and scalable models through longitudinal research and supportive policies will embed resilience as a fundamental component of compassionate healthcare.

INTRODUCTION

Background and rationale

An overview of resilience and its growing relevance in patient treatment is discussed. Emphasis is given on challenges faced by patients, such as cancer, which necessitates strong coping mechanisms. The rationale for integrating resilience assessments into clinical care to improve outcomes is conferred.

Resilience in cancer patients

Cancer patients face substantial physical and psychological challenges, making resilience crucial in recovery and treatment. Despite the stress of diagnosis and treatment, resilience helps patients maintain stable functioning[1,2]. Factors including social, personal and biological elements are influential, contributing to better treatment and psychological outcomes[1]. Posttraumatic growth refers to the positive psychological changes that can occur as a result of struggling with a traumatic event. Posttraumatic growth and positive life changes following crises are closely linked to resilience and are important in cancer recovery[1].

Assessment and interventions

Resilience is typically assessed using emotional and resilience scales. Interventions can be administered via community education, individual/group counselling, and social movements[3]. In cancer care, resilience-promoting interventions include exercise, managing nutrition, cognition, social support and emotional health; pharmacological strategies (cell cycle arrest) may also help during chemotherapy[4]. Psychotherapeutic interventions (e.g., mindfulness training, client-centered counselling, cognitive restructuring) show promise in enhancing resilience[5].

Nursing and holistic care

Oncology nursing is pivotal in fostering resilience by enhancing quality of life, providing emotional support and reducing the social burden of cancer[2,6]. Nurses can effectively assess and manage resilience, contributing to improved quality of life and treatment outcomes[4].

Emerging strategies and future directions

Early intervention in terms of resilience-promoting interventions should extend over multiple sessions and begin soon after diagnosis for maximum benefit[7]. Standard Care integration requires a comprehensive understanding of tailored strategies for individual patient needs and of resilience factors[8]. A unified definition of resilience is needed by taking note of the challenges to ensure consistency in clinical and research applications[8].

DEFINING RESILIENCE IN THE CONTEXT OF PATIENT CARE

Conceptual framework

Psychological resilience is the capacity to adapt well to adversity (disability, medical illness, trauma) while retaining or maintaining physical and psychological health[9]. Resilience emerges under crisis through interconnected human, socio-cultural, biological, and ecological systems that mobilize capacities to sustain, resist, recover, and grow. Resilience is differentiated from mere stress resistance in the light of potential growth and positive adaptation[10]. It should be emphasized that resilience can be developed through interventions as it is a malleable process[9,11].

Measuring resilience

It is now widely acknowledged that robust resilience measures should be validated across cultures, applied longitudinally, and encompass biological, psychological, and social domains. The Connor-Davidson Resilience Scale is a comprehensive self-report tool developed to measure an individual’s overall ability to cope with stress and adversity, while the Brief Resilience Scale offers a succinct assessment of one’s perceived capacity to “bounce back” from challenges. The Resilience Scale for Adults evaluates the personal, familial, and social resources that support resilient functioning, and the Ego-Resiliency Scale gauges an individual’s flexibility in adapting to changing situational demands. Traditional methods include emotional scales and resilience[3]. Novel approaches, such as biomarker-based assessments, provide insights into immune function and neuroendocrine responses[10,12]. The overall measurement should reflect the multidimensional nature (psychological, biological, social)[13].

Interrelationship of physical and psychological resilience

Mental well-being significantly influences physical recovery and vice versa[14]. Integrated assessments that consider both physiological and psychological factors enhance overall health outcomes[14,15]. Examples like studies in chronic illness management and surgical recovery demonstrate this interconnectedness[14].

CURRENT UPDATES IN RESILIENCE RESEARCH

Recent empirical findings

Resilience correlates with improved coping strategies and fatigue, distress, insomnia and reduced psychological distress[16,17]. Alongside strong social networks, active coping strategies (e.g., seeking support, problem-solving) enhance resilience[17,18].

Advances in assessment and measurement

New tools and scales were developed that captured the multifaceted and dynamic nature of resilience[10,16]. Offering opportunities for personalized resilience interventions, the use of mobile and digital health technologies allows real-time monitoring of psychological parameters[10].

Neurobiological and psychosocial insights

There is emerging evidence that underpins resilient behaviours, on neurobiological mechanisms (e.g., neurochemical systems, genetic factors, neural networks)[17,19]. Psychosocial factors, along with gene-environment interactions, play a role in determining resilience outcomes[19,20].

MECHANISMS LINKING RESILIENCE TO TREATMENT OUTCOMES

Psychosocial mechanisms

Social support: It acts as a mediator between treatment adherence and resilience by providing informational, emotional and practical assistance. It buffers stress by moderating environmental and genetic vulnerabilities[21].

Community resources: A sense of empowerment and belonging is fostered through access to mental health services and support groups[21].

Neurobiological underpinnings

Brain plasticity: The brain’s adaptability enables maintenance and recovery of mental health through functional and structural changes[22,23].

Stress regulation: Key for effective recovery and stress modulation are the neuroendocrine responses, particularly via the hypothalamo-pituitary-adrenal axis[24,25].

Holistic patient engagement

Mind-body practices: Positive behavioural changes result from incorporating meditation, mindfulness and similar practices, enhancing neural plasticity in the brain[23].

Stress management techniques: Relaxation exercises and cognitive-behavioural strategies help reduce the physiological impacts of stress and develop coping skills[26].

RESILIENCE-FOCUSED INTERVENTIONS IN CLINICAL PRACTICE

Behavioural and psychosocial interventions

Cognitive behavioural therapy and mindfulness: Significant improvement in resilience is seen with moderate-to-large effect sizes[27]. In a phase II randomised controlled trial of 84 cancer patients, high-intensity Interprofessional Supportive Care in Cancer (digital assessments plus five nurse consultations) outperformed the low-intensity arm on resilience and secondary mood and coping outcomes[28]. The Interprofessional Supportive Care in Cancer program combines triage-driven digital assessments, tailored clinician feedback, and structured nurse-led consultations to address unmet needs, mood, and coping on an ongoing 16-week schedule. Positive effects with effect sizes from 0.33 to 1.45 are noted in cancer patients[7].

Group-based and peer-support initiatives: With improved mood and quality of life, group settings yield large beneficial effects on resilience[7,29].

Digital health interventions

Mobile apps and telemedicine: Offer favourable yet small effects on factors like resilience and mental distress[30]. An example of this is the mPRISM app for young adults and adolescents with cancer, Lau et al[31] conducted a single-site, parallel-arm, waitlist-controlled pilot randomized controlled trial in 80 adolescents and young adults (ages: 12-25) within 12 months of a new cancer diagnosis, randomizing participants 1:1 to receive usual psychosocial care alone (usual care) or usual care plus the fully automated mPRISM mobile app for eight weeks, with assessments at baseline, 8 weeks, and 3-month follow-up[31]. The mPRISM intervention - grounded in stress-and-coping and resilience theory and co-designed with adolescents and young adults- delivers evidence-based coping modules entirely remotely, while the control arm gains access after follow-up; primary outcomes are feasibility (≥ 60% enrollment; ≥ 70% retention) and implementation acceptability and appropriateness (acceptability of intervention measure, intervention appropriateness measure, feasibility measures ≥ 4/5), with exploratory measures including health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep[31]. In low- and middle-income settings, digital resilience tools may face challenges such as limited internet access and device availability; however, short message service-based adaptations and lightweight apps optimized for low-bandwidth environments have shown promise in pilot studies for broader reach.

Wearable technology: Complements digital interventions by tracking recovery metrics and stress in real time.

Multidisciplinary care models

Oncology and palliative care: Patient outcomes are enhanced through the integration of resilience interventions (e.g., cognitive restructuring, mindfulness) in oncology. Prolonged and early interventions are recommended[5,7].

Chronic disease management: Programs focus on improving quality of life and self-management behaviours. A need to operationalize resilience constructs is highlighted through systematic reviews[29,32].

IMPLICATIONS FOR CLINICAL PRACTICE

Assessment and monitoring

Validated psychometric tools should be used to document patient psychological status and assess resilience[33]. Resilience metrics should be standardized in patient records for long-term monitoring and treatment planning[34].

Tailoring interventions to patient needs

Personalised healthcare: Interventions should be adjusted based on psychological, genetic and environmental factors. Such tailored treatment plans would lead to improved outcomes[34]. An example is to use comprehensive geriatric assessments for older adults to customise cancer treatment[35].

Cost-effectiveness and resource optimisation: Resilience-focused care may optimize resources and reduce complications[28].

Enhancing patient-provider communication

Shared decision-making: An open dialogue that aligns treatment plans with patient preferences enhances satisfaction and adherence[36].

Provider training: Recommendations include mindfulness practices, training in communication skills and self-awareness to support patient resilience[37].

CHALLENGES AND FUTURE DIRECTIONS

Barriers to implementation

Standardized measurement gaps: Effectiveness assessment is hindered due to a lack of standard measures for digital interventions[38,39].

Diverse patient needs: Digital interventions must adapt to socio-economic, cultural and individual differences[40].

Ethical and logistical considerations: Issues of informed consent, data privacy and equitable access to technology must be addressed[41,42].

Research gaps and opportunities

There is a need for multi-center and longitudinal studies to evaluate sustainability and long-term effectiveness[43,44]. Through collaborations with community stakeholders and cultural experts, research on culturally sensitive interventions can be pursued[40,45].

Policy and collaborative opportunities

Integration of resilience measures into public health policy should be advocated to broaden the reach of interventions[42,45]. Interdisciplinary collaborations among oncologists, psychiatrists, digital health experts and psychologists to share best resources and practices[41,44].

CONCLUSION

Resilience is linked to improved treatment outcomes in both mental health and physical domains. Examples include reduced stress, anxiety, and depression. and better postoperative outcomes[14,18,46-49]. In chronic conditions, particularly, personalized resilience-focused and holistic interventions demonstrate promise in enhancing quality of life and recovery[49].