Table 1 Overview and definitions of terms used in this paper

Adaptation (Psychology)

Psychological adaptation is the dynamic process, grounded in a person’s intellect and emotions, which maintains a balance in their mental and emotional states, and in their interactions with their social and cultural environments

Recovery (Engineering resilience)

Engineering resilience is synonymous to recovery and focuses on the return of structural and functional attributes of systems to pre-disturbance conditions following a disturbance. The unit of measurement is time of recovery. This definition assumes that systems are characterized by a single equilibrium and therefore fails to account for the potential for alternative regimes of the same system. In bipolar disorder, recovery from a depression or (hypo)manic episode can be regarded as engineering resilience

Coping capacity

The ability of patients to use available resources (clinical practices), skills (learning) and awareness (self-knowledge) to face and manage adverse situations. The strengthening of coping capacities is a means to build resilience to the effects of mental health symptoms and stressful social and other external situations

Response ability

Response ability is a combination of awareness and capability, which is influenced by people’s personalities. Capabilities can be any form of intellect or a physical aspect, and awareness any form of knowledge and experience. Increasing awareness and capability result in increased response ability and determine the speed and magnitude of recovery from, and adaptation to, stressful situations

Ball-in-cup heuristic

This model is commonly applied in ecology to demonstrate resilience concepts. The possibility of complex systems to exist in alternative regimes is shown by different cups. The shape of the cups symbolizes the basin of attraction (stability characteristics of these alternative regimes): deeper and wider cups symbolize a higher resilience of an alternative regime relative to cups that are smaller and shallower. The cup shape can be considered analogous to people’s personalities that influence their adaptation and coping abilities with, for instance, bipolar disorder (see text). The ball symbolizes dynamic stress–response patterns: (1) engineering resilience after disturbances (i.e., when the ball stays within the cup, and (2) ecological resilience when a disturbance threshold is passed (i.e., when the ball rolls to another cup))

Alternative regime

A potential alternative configuration in terms of structural and functional patterns and processes of a system. Alternative regimes are explicit in ecological resilience. In bipolar disorder, the healthy and diseased states can be considered alternative regimes

Ecological resilience

Ecological resilience is a measure of the amount of stress needed to change a complex system from one set of processes and structures to a different set of processes and structures. In bipolar disorder, it is the amount of stress needed to change a patient’s health status from a healthy regime to a permanently diseased regime

Regime shift

A shift in regime is a persistent change in the structure, function, and mutually reinforced processes or feedbacks of a complex system. The change of regimes, or the shift, usually occurs when a change in an internal process (feedback) or a disturbance (external shock) triggers a completely different system behavior. In bipolar disorder, a regime shift occurs when the disorder is triggered in a person

Coerced resilience

Management interventions in an undesired regime to approach conditions of a desired regime. In bipolar disorder, clinical treatment ameliorates symptomatology and aims at approximating conditions of healthy individuals. Coerced resilience means that (1) permanent treatment is needed, (2) that treatment does not restore a healthy regime, and (3) that cessation of treatment restores the full-blown symptomatology of bipolar disorder

Stable equilibrium

Relatively stable system dynamics, which are controlled by a specific set of structural and functional patterns, processes, and feedbacks. In bipolar disorder, mood swings comprise stable equilibrium dynamics within the diseased regime

Emergent properties

A complex systemic feature that cannot be explained by the sum of individual system components. In bipolar disorder, the diseased regime emerges from the complex interplay between genetic, physiological, brain-structural, behavioral, and personality traits of patients, and their interactions with social and environmental factors. This complex interplay determines the symptomatology and their recurrence dynamics

Feedbacks

In ecological systems feedbacks arise from the set of interactions between patterns and processes. Feedbacks control an effect by influencing and being influenced by the process which gave rise to it. A positive feedback enhances or amplifies these processes, while negative feedbacks have the opposite effects. Positive and negative feedbacks generally do not imply any judgment of value regarding the desirability of the effects or outcomes (e.g., healthy vs. diseased regime in bipolar disorder). Positive feedbacks are of most interest in resilience theory; these help maintain structure, function, and processes in specific alternative regimes