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PRISM: A Transformative Approach to Resilience Coaching for Psychosocial Stress in Serious Illness

Therapeutics

Project Overview

Serious and chronic illnesses impose a significant psychosocial burden on patients, caregivers, and healthcare providers. Adolescents and young adults (AYAs) with conditions such as cancer, diabetes, or cystic fibrosis face unique challenges. These include navigating the complexities of illness while managing the developmental milestones of adolescence and early adulthood. This dual burden often leads to higher risks of poor mental health outcomes, including anxiety, depression, and reduced quality of life. Even after recovery, survivors of serious illnesses frequently experience long-term psychosocial challenges, while those with chronic conditions struggle with adherence to treatment plans and self-management.

Caregivers and healthcare workers are not immune to these stressors. Caregivers often experience burnout and emotional exhaustion, while healthcare providers face elevated risks of stress, anxiety, and professional burnout. These challenges highlight the urgent need for scalable, accessible, and evidence-based interventions to address the mental health crisis in individuals with stress-related illnesses.

Traditional mental health interventions, such as cognitive behavioral therapy (CBT), are often resource-intensive and lack the flexibility to meet the diverse needs of individuals facing acute or chronic stress. Recognizing this gap, Abby Rosenberg, MD, MS, MA, Chief, Pediatrics Palliative Care at Dana-Farber and Joyce Yi-Frazier, PhD, Principal Scientist at Dana-Farber developed the Promoting Resilience in Stress Management (PRISM) program. PRISM is a proactive, skills-based intervention designed to build resilience and improve psychosocial outcomes in individuals experiencing stress related to serious illness.

Technology

PRISM is an innovative resilience coaching program that combines evidence-based psychological skills with a flexible delivery model. It is designed to teach participants practical tools to manage stress, improve mental health outcomes, and enhance overall quality of life. The program is tailored to meet the needs of adolescents and young adults with serious illnesses, their caregivers, and healthcare providers, but its applications extend to other high-stress populations as well.

Core Components of PRISM

Structured Resilience Curriculum: PRISM is built around a six-session curriculum, each lasting 30–45 minutes. The sessions are customizable to accommodate the unique needs and schedules of participants, with some groups preferring longer, less frequent meetings and others opting for shorter, more frequent ones. The curriculum focuses on teaching four key resilience skills:
- Stress Management: Techniques to reduce the physiological and emotional impact of stress.
- Positive Reframing: Strategies to shift negative thought patterns and find meaning in challenging situations.
- Goal Setting: Tools to set and achieve realistic, meaningful goals.
Meaning-Making: Exercises to help participants find purpose and value in their experiences.
Flexible Delivery: PRISM sessions are delivered by trained resilience coaches who can work with participants in-person, via video calls, or through text messages. This flexibility ensures accessibility for individuals in diverse settings and circumstances.
Digital App and Workbook: To complement the coaching sessions, PRISM includes a professionally designed smartphone app and a workbook. These tools allow participants to practice resilience skills, track their progress, and access resources in real time. The app, which won a Health Innovation Award, is particularly valuable for providing support during moments of acute stress, such as late at night when professional help may not be immediately available.

PRISM has been rigorously tested in over a decade of research, including randomized controlled trials and cohort studies. More than 500 individuals have participated in randomized trials, with hundreds involved in other studies. PRISM has been implemented in diverse settings around the world, including:

Adolescents with newly diagnosed cancer in Sweden.
Adolescents with brain tumors in Ohio.
Adolescents with HIV in Eswatini, Africa.
Children and adolescents with mental disorders in Germany.
Parents of children with diabetes in Australia.

The program has consistently demonstrated its ability to improve psychosocial outcomes across diverse populations:

Adolescents and Young Adults with Cancer: PRISM has been shown to improve resilience, hope, and cancer-specific quality of life while reducing distress and inflammation markers associated with stress.
Caregivers of Youth with Cancer: Participants reported increased resilience and benefit-finding, highlighting the program’s positive impact on those supporting loved ones through illness.
Adolescents with Type 1 Diabetes: PRISM participants experienced reduced distress and improved self-management behaviors, demonstrating its applicability to chronic conditions.
Healthcare Workers: During the COVID-19 pandemic, PRISM was associated with reduced stress, anxiety, and burnout, as well as improved resilience among frontline healthcare providers.
Other Populations: PRISM has also been successfully implemented in individuals with cystic fibrosis, sickle cell disease, chronic pain, and congenital heart disease, as well as caregivers of children with craniofacial conditions.

PRISM represents a transformative approach to addressing the psychosocial challenges associated with serious illness by consistently improving resilience, hope, and self-efficacy—key psychological skills that enable individuals to navigate stress and maintain a sense of control over their lives. The program has demonstrated its ability to reduce symptoms of anxiety and depression, enhance quality of life, and mitigate the long-term psychosocial impacts of serious illness across diverse populations. With its evidence-based design, customizable delivery, and digital tools, PRISM is uniquely positioned to meet the growing demand for accessible, scalable mental health interventions.

Team Members: Joyce Yi-Frazier, PhD, Abby Rosenberg, MD, MS, MA, Courtney Junkins, PsyD

Applications

PRISM’s flexible, evidence-based design makes it a versatile tool for addressing psychosocial stress in a variety of settings and populations. Its applications include:

Patients with Serious or Chronic Illnesses: PRISM is particularly effective for individuals facing the stress of conditions such as cancer, diabetes, or other chronic diseases. By teaching resilience skills, the program helps patients improve their quality of life and cope more effectively with the challenges of their illness.
Caregivers: Caregivers often experience significant stress as they support loved ones through serious medical conditions. PRISM provides them with tools to manage their own mental health, enabling them to better care for both themselves and their loved ones.
Healthcare Workers: The high-stress environment of healthcare, particularly during crises like the COVID-19 pandemic, can lead to burnout and mental health challenges. PRISM has been successfully implemented to support healthcare providers, improving their resilience and reducing stress.
Youth and Adolescents: PRISM has been tailored for young people facing medical challenges, such as cancer or chronic pain, as well as their caregivers. Its engaging format and age-appropriate content make it particularly effective for this demographic.
Digital Therapeutics and On-Demand Wellness: PRISM’s digital app and flexible delivery model position it as a valuable tool in the growing field of digital therapeutics. The program aligns with the increasing demand for on-demand wellness solutions, offering a scalable and accessible option for mental health support.

Opportunities

PRISM is available for licensing to collaborations interested in:

implementing PRISM across new sectors and regions.
utilizing data insights to drive advancements in mental health treatment.
integrating on-demand health services into an organization’s existing frameworks for improved patient outcomes.

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