Building Psychological Immunity in Children and Adolescents by Tanu Gupta, Naresh Nebhinani

Editorial J. Indian Assoc. Child Adolesc. Ment. Health 2020;16(2):1-12
Building Psychological Immunity in Children and Adolescents
Tanu Gupta, Naresh Nebhinani
Department of Psychiatry, All India Institute of Medical Sciences,
Jodhpur, Rajasthan. Email: drnaresh_pgi@yahoo.com

(emphasis added-Murthy)

At the beginning let us share a very painful incident which raised many concerns and questions in our mind and we found ourselves shocked and speechless…

“Few days back, there was a news about a 10-year-old child (student of 5th class) who was asked to give away the mobile phone and to focus on studies by his mother. He got so distressed with this remark that he locked himself in a room. Few hours later, when mother started calling him and he didn’t open the door. Then family member broke the door and found that he allegedly hanged himself to the fan and later he was declared dead in hospital.”

Subsequently while pondering on this information, we come across several questions that why children are not able to tolerate such simple remarks, why they are not equipped to regulate their emotions and to respond appropriately and why they are engaging in such impulsive behaviours without considering the aftermath?

We were looking for the answers and came across the concept of “Psychological immunity” from where we tried to canvass this editorial.

As we see lot of changes in the environment in last two decades.

To a larger extent, each one of us has changed psychologically and physically. However, the speed of change is not parallel with the speed of adaptation for children and adolescents in today’s world.

We talk about environmental pollutant, viruses, infections and physical hassles at length and try to protect children from their harmful effects through regular immunization and other preventive measures.

What about the changes at psychological level?
• Are we talking about this?
• And are we building the immunity against these variables?

Psychological problems are occurring at an early age and children and adolescents are considered as a vulnerable group [1]. The kind of exposure to stress, culture of abundance and competition available for today’s generation is far beyond their ability to handle the situation in a competent manner. The changing trend can also be observed in our clinical practice wherein a lot of children and adolescents present with difficulties in handling the day to day stressors, poor emotional/self-regulation and inability to delay gratification. We see lot of clinical disorders/problems have their precursors in early childhood experiences, rearing practices, parenting at large along with child’s own learning of maladaptive coping skills from the environment [2].

Parents are either overinvolved with the kids or sometime not involved at all. Both the overprotective parenting as well as neglected parenting has its own impact on the development of children [3]. We, as parents are teaching so many things at a go with lots of restrictions (No’s) to children and thus impeding the building of their adaptive psychological immunity for natural environmental and social stressors. The major change has also been seen in the reduction of their real-life interaction owing to the advent of smartphones, all time access to internet and lots of virtual games. All these changes have impacted the development of social skills, problem solving abilities and self-regulation abilities of children and adolescents [4].

Considering the current need, the role of building psychological immunity of children and adolescents is crucial, not only to protect them but also for making them skilled to handle the changing scenario worldwide. Immunity as the term suggest is an individual’s defense against various infection, viruses or toxins through the action of specific antibodies. Physical immunity protects children from different bacterial, viral and other infections of the environment [5].

Similarly, psychological immunity protects them from various environmental stressors, hassles and negative experiences. A person’s response to stress is largely dependent on the functioning of his or her psychological immune system [6].

Defining Psychological Immunity

The term “Psychological immunity” was coined by Attila Olah in 2000 [7]. He defined
psychological immune system as a comprehensive system of adaptive resources that provide
immunity against stress, promote healthy personality development and act as psychological
antibodies. It includes various cognitive, behavioral and motivational strengths that encourage children’s capacity to tolerate stress, handle threats and promote healthy psychosocial development [7].

Model of Psychological Immune system

Psychological Immune system (PIS) is built upon the following 16 adaptive resources that
interact with each other to facilitate the process of psychological adaptation [7]:

1. Positive thinking facilitates the anticipation of positive outcomes in all circumstances of life and encourage individual to believe that the events are moving in the right directions. This positive anticipation directly influences the process of primary appraisal [8]. The main resource of positive thinking is optimism/hopefulness. Children with high degree of optimism anticipate positive results and favourable outcomes even in the situations that are not in their controls.

2. Sense of coherence is a tendency to appraise life situations as predictable and manageable. The sense of coherence holds a prime importance in determining the meaningfulness of positive and negative life events in one’s life. Inculcating sense of coherence in children and adolescent can enhance their belief about the environmental predictability. It will further facilitate their ability to handle situation in a calm state and prevent the state of chaos and confusion [9]

3. Sense of control is widely studied phenomena which include different dimensions of control. Basically it is an individual’s sense of personal influence on various life events. Children with high levels of perceived sense of control believe on their abilities to change their everyday environments rather than being under the control of events and dependent on chance.

4. Sense of personal growth is a feeling of successful self-expansion and personal growth. It gives you a sense of becoming healthy, mature and fully functioning individual. An individual’s expectation of self-growth encourages openness towards new experiences [10].

5. Social Creating Capacity is a related to the social competence that helps an individual to establish various social relationships in the form of social groups or teams. People who have this skill hold a personality that helps other people to feel connected. In the era of smart phone and virtual relationships, having this skill in store can help children and adolescent to develop appropriate social skills and real relationships to overcome
the feelings of loneliness and isolation

6. Social executing ability involves the skills required to motivate, govern, and manage human resources for the achievement of various goals. People high on this ability have good leadership skills, high level of social assertiveness and effective communication skills.

7. Social monitoring ability involves empathetic understanding of other people’s
concerns. Individual having high level of social monitoring capacity will have better understanding of the social environmental cues and social behavior of people around.

8. Creative self-concept is a belief of an individual about one’s abilities and creative competence that helps them in dealing different life situations in a more competent manner [11].

9. Change and challenge orientation encourages individuals to face change in a more flexible way. Children and adolescents having high level of change and challenge orientation can tolerate uncertainty and are open to new experiences. They anticipate change as a norm of life and a chance for self-development. They face various challenges of life such as illness, death, failure in more competent manner [12].

10. Problem solving capacity is related to the ability to look for alternative solutions for various problem situations of life.

11. Self-efficacy is an individual’s belief on his own abilities to perform a certain task [13].Number of studies have incorporated the component of self-efficacy in their school mental health interventions and youth development program and found its implication in the area of academic performance as well as extracurricular skills.

12. Goal orientation is ability to have the motivation and persistence towards
accomplishment of the desired goals even in the presence of various obstacles and adversities. Goal oriented individuals have high levels of frustration tolerance and endurance. Inculcating goal orientation with high level of self-efficacy in students can influence their level of school engagement. It will further enhance their willingness to set higher goals for themselves and achieve them through overcoming the various challenges [14].

13. Synchronicity is the ability to be present on task along with the awareness about the other environmental change. Having high level of synchronicity helps an individual to be present in the moment with maximum level of concentration on the concurrent issues whereas lack of synchronicity enhances behavioural disengagement and avoidance (maladaptive coping).

14. Impulsivity control is the ability to control impulses, rationalize behavior and contemplate a decision before acting on it.

15. Emotion control is the ability to regulate emotions originated from stressful situations in day to day encounters. Children and adolescent with good emotional control will recover early from a negative emotional state for example a child who scored less in math’s exam can recover from disappointment in a short period of time [15].

16. Irritability control is related regulation of temper and anger in a given situation. Individual with poor irritability control tend to lose their temper easily and often create problems for themselves as well as for others.

All the 16 psychological strengths described above holds a crucial role in the shaping of developing brain as well as their personality. It becomes more relevant for children and adolescents as they learn all these positive skills during their growth years and once they enter adulthood, the pattern once established will remain more or less the same. All skills act as package in building psychological immunity that helps people to handle external pressures,
threats and stressors.

Functions of psychological immune system

Functions of psychological immune system are largely similar to the biological immune system [16] such as:
Both are protective from illness
• Both have self-healing properties
• Both are automatic in their functioning
• Both are adaptive in nature
• Functioning of both can be affected by stress
• Both are invisible and not easily accessible
• Both can be targeted for improvement with deliberate interventions

Importance of psychological immune system

Psychological immune system helps in dealing with conflicting emotions. It acts as a character strength that helps individuals to face their fears, anxieties and environmental threats in a more competent manner. Individuals possessing good psychological immunity are adaptive and flexible in a given situation. PIS also encourage people to take responsibility for their own actions and life [17]. Maladaptive or compromised functioning of PIS can lead to maladaptive coping behaviours such as smoking, alcohol abuse, high risk behaviours and poor emotional regulation in adolescents. Suicide has been conceptualised as an ultimate failure of PIS [18].

Persistent, chronic and frequently relapsing psychological disorders such as depression, anxiety, obsessive compulsive disorder etc. have also been seen as reflection of compromised PIS [18].

Coping is basic mechanism of PIS through which it handles the day to day mental hassles and stressor so building of various coping skills as a part of psychological immunity enhancer can prevent the development of psychological disorders in children and adolescents. Moreover, good psychological immunity with the various coping resources described above also helps an individual to prevent as well as recover from various psychological disorders.

How to build psychological immunity?

Psychological immunity can be targeted through deliberate, purposeful and planned intervention. Effects of pharmacological interventions on PIS have been found to be limited whereas experiential/behavioural learning, resilience training along with the controlled exposure to stress contributes significantly in the development of psychological immune system.

Majority of the psychological intervention target underlying cognitive processes
through purposeful interventions as negative cognitions are found to be the major influential factor in the development of various psychological problems in children and adolescents [18].

Psychological immunity acts as buffer from psychological problems. We encounter many such individuals in psychiatric care who are unable to handle minor stressors of life and end up with one or the other psychological problems. At the same time, many examples are available where individuals are exposed to severe life stressors yet they stand still and maintained their balanced state of mind. So individual’s response and tolerance for life situations differ significantly. As per the current understanding, the commonly available rationale for this relies mainly on the coping abilities of an individual rather than the inbuilt psychological immunity that act as defense for different stressors [16]. Scarcity of literature in PIS limits our understanding about the PIS however the various components of PIS have been studied by the number of researchers under different headings.

Building psychological immunity is essential for overall psychosocial development of children and adolescents. The main stakeholders involved in building psychological immunity are parents, teachers and significant others who can provide following environmental stimulation (at home, school or community) for enriching the child’s repertoire:

Enhance connectedness
• Show affection/love (physical & verbal ways)
• Build trusted relationship
• Provide and convey unconditional love & support
• Allow the expression of all emotions
• Make them feel safe & secure
• Encourage real life communication & connection
• Get to know children’s friends
• Stay involved in children’s homework and activities
• Encourage good problem-solving skills
• Resist the urge to fix up all problems, or issues, faced by children and adolescents
• Let them brainstorm different ideas and solutions
• Acknowledge their ideas and solution
• Encourage self-reliance for acting upon the solutions
• Strengthen their executive functioning
• Encourage their self-management skills in different situations
• Establish routines
• Provide opportunities to make their own decisions
• Encourage involvement in games that inculcate impulse control (by taking turns) and
• cognitive flexibility (shifting from one task/role to another)
• Encourage flexibility towards change
• Inculcate sense of responsibility by assigning chores as per their ability
• Give appreciation for their efforts
• Nurture optimism
• Parent/teachers can model optimism in their day to day interactions
• Encourage them for interpreting failure as an opportunity
• Encourage goal setting and accomplishment
• Challenge negative interpretations about situations by acknowledging their
• views about the world and also encourage them for different views
• Promote healthy/safe risk taking
• Encourage children to make safe mistakes
• Encourage them to develop a sense of right versus wrong and look beyond
• immediate gratification of needs
• Encourage them to learn new skills such as a new sport, new skills, participating
• in school programs, expose them to various social situations
• Encourage them to face their fears by gradually exposing them to such situations
• Enhance their self confidence
• Encourage help seeking/giving
• Set an example of being involved in prosocial behaviour and being empathetic for
• other’s concerns
• Ask for help whenever needed
• Inculcate positive attitude for help seeking/giving
• Demonstrate how our behaviour affect others and vice versa
• Inculcate good reading habits
• Provide good literature to read
• Encourage regular reading habits can open their minds to several things and create a
• good platform for cognitive restructuring [16]

To conclude, all the above environmental manipulation and stimulation can be done at familial level, school level and community level. Well-established interventions are not available for building PIS but different adaptive resources can be targeted through tailor made interventions as per the need of the group [16,18]. Investing time and energy in building PIS is worth of preventing number of psychological problems in children and adolescents. There is a strong need for conducting evidence based research to find out the clinical implications of PIS model in children and adolescents. Research in PIS is in its infancy therefore it is too early to derive any clinical implications however the phenomenon seems to have relevance in today’s world. Considering the early onset of mental health problems in children and adolescents, it is essential to initiate comprehensive preventive interventions at an early age. These preventive interventions may target various adaptive resources of psychological immune system through resilience training, distress tolerance skills, life skills training, connectedness and problem solving skills for children and adolescents. Interventions should involve parents, teachers and significant others as they play an important role in shaping an individual’s personality. Targeting only children will not work as their behaviour and coping is largely determined by the environment and modelling of their parent or teacher’s behaviour. Thus timely identification and mending the maladaptive coping at appropriate level is required to make the intervention effective.

Acknowledgment: None declared
Conflict of interest: None declared

References

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Tanu Gupta, Clinical Psychologist, Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan; Naresh Nebhinani, Additional Professor, Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan.

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