Positive appraisal style predicts long-term stress resilience and mediates the effect of a pro-resilience intervention

Papoula Petri-Romão; Roberto Mediavilla; Alexandra Restrepo-Henao; Lara M. C. Puhlmann; Matthias Zerban; Kira F. Ahrens; Corrado Barbui; Ulrike Basten; Carmen Bayón; Andrea Chmitorz; Mireia Felez-Nobrega; Bianca Kollmann; Klaus Lieb; David McDaid; Kerry R. McGreevy; Maria Melchior; Ainoa Muñoz-Sanjosé; Rebecca J. Neumann; A. La Park; Michael M. Plichta; Marianna Purgato; Andreas Reif; Charlotte Schenk; Anita Schick; Alexandra Sebastian; Marit Sijbrandij; Pierre Smith; Oliver tüscher; Michèle Wessa; Anke B. Witteveen; Kenneth S. L. Yuen; Josep Maria Haro; José Luis Ayuso-Mateos; Raffael Kalisch

doi:10.1038/s41467-025-65147-7

Positive appraisal style predicts long-term stress resilience and mediates the effect of a pro-resilience intervention

Papoula Petri-Romão
, Roberto Mediavilla^*
, Alexandra Restrepo-Henao
, Lara M. C. Puhlmann
, Matthias Zerban
, Kira F. Ahrens
, Corrado Barbui
, Ulrike Basten
, Carmen Bayón
, Andrea Chmitorz
, Mireia Felez-Nobrega
, Bianca Kollmann
, Klaus Lieb
, David McDaid
, Kerry R. McGreevy
, Maria Melchior
, Ainoa Muñoz-Sanjosé
, Rebecca J. Neumann
, A. La Park
, Michael M. Plichta

Marianna Purgato, Andreas Reif, Charlotte Schenk, Anita Schick, Alexandra Sebastian, Marit Sijbrandij, Pierre Smith, Oliver tüscher, Michèle Wessa, Anke B. Witteveen, Kenneth S. L. Yuen, Josep Maria Haro, José Luis Ayuso-Mateos, Raffael Kalisch

^*Corresponding author for this work

Midwifery Science

Leibniz Institute for Resilience Research
Universidad Autónoma de Madrid
Centro de Investigación Biomèdica en Red de Salud Mental (CIBERSAM)
Hospital Universitario de la Princesa
Columbia University
Universidad de Antioquia
Technische Universität Dresden
Johannes Gutenberg University Mainz
Goethe University Frankfurt
University of Verona
The University of Kaiserslautern-Landau
Hospital Universitario La Paz
Instituto de Investigación Sanitaria del Hospital Universitario La Paz
Esslingen University of Applied Sciences
Sant Joan de Déu Research Institute
Parc Sanitari Sant Joan de Déu
Zentralinstitut fur Seelische Gesundheit
The London School of Economics and Political Science
Sorbonne Université
Heidelberg University
Vrije Universiteit Amsterdam
Sciensano
Université catholique de Louvain
Martin Luther University Halle-Wittenberg
Partner site Halle-Jena-Magdeburg
German Cancer Research Center
University of Barcelona

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Stress resilience is the maintenance of mental health despite adversity. Identifying factors that predict and promote good long-term mental health outcomes in stressor-exposed individuals is a first step towards developing more effective prevention programs. In two independent observational samples (N = 132, N = 1034), we find that a tendency to evaluate stressors in a realistic to slightly unrealistically positive fashion (positive appraisal style, PAS) is prospectively associated with resilient outcomes over several years. We also find that PAS is an integrative, proximal resilience factor that mediates the pro-resilience effects of other protective factors (e.g., social support). In an analysis of pre-specified exploratory outcomes of a randomized controlled trial comparing a behavioral intervention targeting a broad set of resilience factors against usual care in a sample of distressed healthcare workers (N = 232; trial registry: NCT04980326), we find that PAS is modifiable, with improvements in PAS mediating intervention-induced improvements in resilience. These results establish PAS as a proximal, plastic, and potentially causal resilience factor.

Original language	English
Article number	10269
Journal	Nat. Commun.
Volume	16
Issue number	1
DOIs	https://doi.org/10.1038/s41467-025-65147-7
Publication status	Published - 1 Dec 2025

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Petri-Romão, P., Mediavilla, R., Restrepo-Henao, A., Puhlmann, L. M. C., Zerban, M., Ahrens, K. F., Barbui, C., Basten, U., Bayón, C., Chmitorz, A., Felez-Nobrega, M., Kollmann, B., Lieb, K., McDaid, D., McGreevy, K. R., Melchior, M., Muñoz-Sanjosé, A., Neumann, R. J., Park, A. L., ... Kalisch, R. (2025). Positive appraisal style predicts long-term stress resilience and mediates the effect of a pro-resilience intervention. Nat. Commun., 16(1), Article 10269. https://doi.org/10.1038/s41467-025-65147-7

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title = "Positive appraisal style predicts long-term stress resilience and mediates the effect of a pro-resilience intervention",

abstract = "Stress resilience is the maintenance of mental health despite adversity. Identifying factors that predict and promote good long-term mental health outcomes in stressor-exposed individuals is a first step towards developing more effective prevention programs. In two independent observational samples (N = 132, N = 1034), we find that a tendency to evaluate stressors in a realistic to slightly unrealistically positive fashion (positive appraisal style, PAS) is prospectively associated with resilient outcomes over several years. We also find that PAS is an integrative, proximal resilience factor that mediates the pro-resilience effects of other protective factors (e.g., social support). In an analysis of pre-specified exploratory outcomes of a randomized controlled trial comparing a behavioral intervention targeting a broad set of resilience factors against usual care in a sample of distressed healthcare workers (N = 232; trial registry: NCT04980326), we find that PAS is modifiable, with improvements in PAS mediating intervention-induced improvements in resilience. These results establish PAS as a proximal, plastic, and potentially causal resilience factor.",

author = "Papoula Petri-Rom{\~a}o and Roberto Mediavilla and Alexandra Restrepo-Henao and Puhlmann, \{Lara M. C.\} and Matthias Zerban and Ahrens, \{Kira F.\} and Corrado Barbui and Ulrike Basten and Carmen Bay{\'o}n and Andrea Chmitorz and Mireia Felez-Nobrega and Bianca Kollmann and Klaus Lieb and David McDaid and McGreevy, \{Kerry R.\} and Maria Melchior and Ainoa Mu{\~n}oz-Sanjos{\'e} and Neumann, \{Rebecca J.\} and Park, \{A. La\} and Plichta, \{Michael M.\} and Marianna Purgato and Andreas Reif and Charlotte Schenk and Anita Schick and Alexandra Sebastian and Marit Sijbrandij and Pierre Smith and Oliver t{\"u}scher and Mich{\`e}le Wessa and Witteveen, \{Anke B.\} and Yuen, \{Kenneth S. L.\} and Haro, \{Josep Maria\} and Ayuso-Mateos, \{Jos{\'e} Luis\} and Raffael Kalisch",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = dec,

day = "1",

doi = "10.1038/s41467-025-65147-7",

language = "English",

volume = "16",

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Petri-Romão, P, Mediavilla, R, Restrepo-Henao, A, Puhlmann, LMC, Zerban, M, Ahrens, KF, Barbui, C, Basten, U, Bayón, C, Chmitorz, A, Felez-Nobrega, M, Kollmann, B, Lieb, K, McDaid, D, McGreevy, KR, Melchior, M, Muñoz-Sanjosé, A, Neumann, RJ, Park, AL, Plichta, MM, Purgato, M, Reif, A, Schenk, C, Schick, A, Sebastian, A, Sijbrandij, M, Smith, P, tüscher, O, Wessa, M, Witteveen, AB, Yuen, KSL, Haro, JM, Ayuso-Mateos, JL & Kalisch, R 2025, 'Positive appraisal style predicts long-term stress resilience and mediates the effect of a pro-resilience intervention', Nat. Commun., vol. 16, no. 1, 10269. https://doi.org/10.1038/s41467-025-65147-7

TY - JOUR

T1 - Positive appraisal style predicts long-term stress resilience and mediates the effect of a pro-resilience intervention

AU - Petri-Romão, Papoula

AU - Mediavilla, Roberto

AU - Restrepo-Henao, Alexandra

AU - Puhlmann, Lara M. C.

AU - Zerban, Matthias

AU - Ahrens, Kira F.

AU - Barbui, Corrado

AU - Basten, Ulrike

AU - Bayón, Carmen

AU - Chmitorz, Andrea

AU - Felez-Nobrega, Mireia

AU - Kollmann, Bianca

AU - Lieb, Klaus

AU - McDaid, David

AU - McGreevy, Kerry R.

AU - Melchior, Maria

AU - Muñoz-Sanjosé, Ainoa

AU - Neumann, Rebecca J.

AU - Park, A. La

AU - Plichta, Michael M.

AU - Purgato, Marianna

AU - Reif, Andreas

AU - Schenk, Charlotte

AU - Schick, Anita

AU - Sebastian, Alexandra

AU - Sijbrandij, Marit

AU - Smith, Pierre

AU - tüscher, Oliver

AU - Wessa, Michèle

AU - Witteveen, Anke B.

AU - Yuen, Kenneth S. L.

AU - Haro, Josep Maria

AU - Ayuso-Mateos, José Luis

AU - Kalisch, Raffael

PY - 2025/12/1

Y1 - 2025/12/1

N2 - Stress resilience is the maintenance of mental health despite adversity. Identifying factors that predict and promote good long-term mental health outcomes in stressor-exposed individuals is a first step towards developing more effective prevention programs. In two independent observational samples (N = 132, N = 1034), we find that a tendency to evaluate stressors in a realistic to slightly unrealistically positive fashion (positive appraisal style, PAS) is prospectively associated with resilient outcomes over several years. We also find that PAS is an integrative, proximal resilience factor that mediates the pro-resilience effects of other protective factors (e.g., social support). In an analysis of pre-specified exploratory outcomes of a randomized controlled trial comparing a behavioral intervention targeting a broad set of resilience factors against usual care in a sample of distressed healthcare workers (N = 232; trial registry: NCT04980326), we find that PAS is modifiable, with improvements in PAS mediating intervention-induced improvements in resilience. These results establish PAS as a proximal, plastic, and potentially causal resilience factor.

AB - Stress resilience is the maintenance of mental health despite adversity. Identifying factors that predict and promote good long-term mental health outcomes in stressor-exposed individuals is a first step towards developing more effective prevention programs. In two independent observational samples (N = 132, N = 1034), we find that a tendency to evaluate stressors in a realistic to slightly unrealistically positive fashion (positive appraisal style, PAS) is prospectively associated with resilient outcomes over several years. We also find that PAS is an integrative, proximal resilience factor that mediates the pro-resilience effects of other protective factors (e.g., social support). In an analysis of pre-specified exploratory outcomes of a randomized controlled trial comparing a behavioral intervention targeting a broad set of resilience factors against usual care in a sample of distressed healthcare workers (N = 232; trial registry: NCT04980326), we find that PAS is modifiable, with improvements in PAS mediating intervention-induced improvements in resilience. These results establish PAS as a proximal, plastic, and potentially causal resilience factor.

UR - https://www.scopus.com/pages/publications/105022671194

U2 - 10.1038/s41467-025-65147-7

DO - 10.1038/s41467-025-65147-7

M3 - Article

C2 - 41271713

SN - 2041-1723

VL - 16

JO - Nat. Commun.

JF - Nat. Commun.

IS - 1

M1 - 10269

ER -

Positive appraisal style predicts long-term stress resilience and mediates the effect of a pro-resilience intervention

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