title: The efficacy of resiliency training programs: a systematic review and meta-analysis of randomized trials.
abstract: OBJECTIVE
  Poor mental health places a burden on individuals and populations. Resilient persons are able to adapt to life's challenges and maintain high quality of life and function. Finding effective strategies to bolster resilience in individuals and populations is of interest to many stakeholders.
  
  
  OBJECTIVE
  To synthesize the evidence for resiliency training programs in improving mental health and capacity in 1) diverse adult populations and 2) persons with chronic diseases.
  
  
  METHODS
  Electronic databases, clinical trial registries, and bibliographies. We also contacted study authors and field experts.
  
  
  METHODS
  Randomized trials assessing the efficacy of any program intended to enhance resilience in adults and published after 1990. No restrictions were made based on outcome measured or comparator used.
  
  
  METHODS
  Reviewers worked independently and in duplicate to extract study characteristics and data. These were confirmed with authors. We conducted a random effects meta-analysis on available data and tested for interaction in planned subgroups.
  
  
  RESULTS
  The standardized mean difference (SMD) effect of resiliency training programs on 1) resilience/hardiness, 2) quality of life/well-being, 3) self-efficacy/activation, 4) depression, 5) stress, and 6) anxiety.
  
  
  RESULTS
  We found 25 small trials at moderate to high risk of bias. Interventions varied in format and theoretical approach. Random effects meta-analysis showed a moderate effect of generalized stress-directed programs on enhancing resilience [pooled SMD 0.37 (95% CI 0.18, 0.57) p = .0002; I2 = 41%] within 3 months of follow up. Improvement in other outcomes was favorable to the interventions and reached statistical significance after removing two studies at high risk of bias. Trauma-induced stress-directed programs significantly improved stress [-0.53 (-1.04, -0.03) p = .03; I2 = 73%] and depression [-0.51 (-0.92, -0.10) p = .04; I2 = 61%].
  
  
  CONCLUSIONS
  We found evidence warranting low confidence that resiliency training programs have a small to moderate effect at improving resilience and other mental health outcomes. Further study is needed to better define the resilience construct and to design interventions specific to it.
  
  
  BACKGROUND
  PROSPERO #CRD42014007185.
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Leppin
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Pavithra R
authors.initials: PR
authors.lastname: Bora
authors.affiliation: Integrative Medicine Program-Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America; Mayo Graduate School, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Gionfriddo
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Claudia
authors.initials: C
authors.lastname: Zeballos-Palacios
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Dulohery
authors.affiliation: Integrative Medicine Program-Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Amit
authors.initials: A
authors.lastname: Sood
authors.affiliation: Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America; Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Brito
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Kasey R
authors.initials: KR
authors.lastname: Boehmer
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America; Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D000328:Adult; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D055500:Resilience, Psychological; D013315:Stress, Psychological / Q000628:therapy*