The organizers asked for ideas for helping patients and families as well as for keeping nurses’ own energy strong. I decided to organize my thoughts here, so that the community could tell me if there is something important that I am forgetting, as I review previous articles on resilience including the ones in the PPND resilience book.
Here are ideas that I am considering presenting. Since I’m not sure I have time for so many ideas, the next step will be to decide which are most crucial.
- Resilience in the moment is physical. When dealing with an immediate adversity, calming the body comes first. In his Edutopia video, Richard Davidson calls it down-regulating amygdala responses. When your physiological fight-or-flight mechanism is aroused, it’s very hard to do anything else. Preparation helps. One way to prepare for future adversity is to practice calming down, exploring to find your own best approach. Wayne Jencke described research that simply naming the negative emotions that you feel can lead to greater calm. Other useful approaches include slow and regular breathing, yoga, and physical exercise.
- Resilience is physical in the long haul as well. Your overall physical welfare makes a difference. We all know about the physical benefits of adequate sleep, good nutrition, and physical activity. Perhaps we don’t all think of them as an investment in future capacity to bounce back. I am also reminded of research by Winwood and colleagues that active leisure contributes to day-to-day recovery from stress. (See summary here.)
- Resilience is enabled by an open and curious awareness that doesn’t try to hide or deny adversity or the negative feelings that come from it. Todd Kashdan’s research on strivings suggests that trying to get rid of negative emotions depletes our stocks of self control, a precious and limited resource. Perhaps it takes more than we can afford. People who are curious and open learn to become aware of differences among their negative emotions. They can distinguish between anger, anxiety, sadness, fear, shame, and so on. In a different paper, Todd Kashdan and colleagues show that people who are better at describing emotions tend to be less likely to self-medicate with alcohol, surely a sign of greater resilience.
- Positive emotions are possible even in times of trouble and loss, and they contribute to recovery and growth. With open and curious awareness, people are more likely to notice the good things that happen as well as the hard things. Michelle Tugade and Barbara Fredrickson studied ways that people use positive emotions to bounce back from negative experiences. In the three studies, they found that positive emotion led to accelerated physical recovery from negative arousal and that it also helped people find meaning in negative situations.
Open and curious awareness is important for positive emotions as well as negative ones. Celebrating small successes is important. I asked my cousin who is a nurse for her thoughts about resilience. She told me that of course nurses need to care for the most urgent needs, but the nurses who also notice and celebrate decreases in need tend to find it easier to keep their energy up.
- Resilience can draw strength from the meaning inherent in the situation, though it may take imagination to see it. For example patients probably seldom think of the meaning they give to the nurses who care for them. This was one of the surprising points I learned at the Biennial Meaning Conference this summer, as reported in Finding Meaning in a Shrinking World.
- an article that became one of the chapters in the Resilience book. It shows up in many ways. My husband and I laugh together that we used the tag-team wrestling approach to raising children. Whenever one of us was ready to snap, we could tag the other and say, “You’re it!” My cousin suggested that nurses can watch out for each other in the same way.
A young friend worked with HIV-infected mothers in an inner-city environment. She found that the most effective way she could help them was to set up meetings with other HIV-infected mothers facing the same challenges. Certainly social connections are a lynch pin of programs like Alcoholics Anonymous. When I was writing about the grief I experienced with a sudden loss, I came across a paper by Benkel that stated that people find it easier to talk to others who have faced similar losses, “in that such persons were able to understand their feelings without having to explain them in words.”
Resilience is social. Dave Shearon describes this in
- There are habits of thought that assist resilience. This doesn’t mean the same thing as trying to regulate feelings directly, which so often leads to second-level reactions. For example, “I’m angry” leading to “What’s wrong with me that I get so angry about things?” Instead these habits involve trying out new ways of looking at the same situation, so see if there aren’t ways of interpreting it that are just as likely to be true, but leave you in a better place.
For example, I talked to a parent who was distressed because her son would come home from school and be very unpleasant to her. Her initial thought was, “I am an unsuccessful parent because he says these things to me.” When she started thinking, “Hmmm, maybe I am the safest person in the world to hear about these things,” she had different feelings. It was a matter of interpretation. The explanatory style examples that Sherri Fisher just discussed for job seekers are another example.
My favorite resource for this idea is Sandra Schneider’s paper on realistic optimism. Realistic optimism doesn’t mean denying unpleasant facts. It means distinguishing between facts and matters of interpretation, and then selecting interpretations that helpful rather than hurtful.
- Resilience can involve letting go of “lost possible selves” — those dreams and goals that are lost causes and can no longer occur. Thinking about them can contribute to ego development and maturity. While exploring the the ability of adults to confront lost goals, Laura King and Joshua Hicks suggest, “Rather than stopping with the conclusion that regret is negatively related to well-being, we suggest that the capacity to acknowledge what is regrettable in life emerges from maturity and contributes to maturation itself.”
One family got a companion dog that is a social magnet for their son, whom otherwise people would avoid. I tried to nominate one of the children for Robert Biswas-Diener’s Courage award, but he declined. They don’t think of themselves as brave, but to me they are heroes.
We can watch for the heroes of resilience around us and can keep their stories in mind when our own times are tough. I think, for example of friends who have had children with severe health difficulties. Day by day, year after year, they have built lives around their children’s needs — giving up some of their initial dreams and creating new pictures of the future.
- We can also watch for sources of resilience that are already there in our own lives and communities. My nurse cousin suggested that nurses often have resilient habits that they don’t even think about. This reminded me of Atul Gawande’s description of positive deviance, as practiced by Jerry and Monique Sternin, as “the idea of building on capabilities that people already had rather than telling them how they had to change.”
I listened to Caroline Miller’s podcast of her interview with Laura King as part of my preparation. I liked Dr. King’s suggestion that we allow ourselves to be surprised by life. That’s what I think resilient people do. They have learned to be grateful for the moments of surprise and treasure the opportunity to grow, no matter how difficult.
Benkel, I., Wijk, H., & Molander, U. (2009). Family and friends provide most social support for the bereaved. Palliative Medicine, 23, 141-149.
Kashdan, T.B., Ferssizidis, P., Collins, R.L., & Muraven, M. (in press). Emotion differentiation as resilience against excessive alcohol use: An ecological momentary assessment in underage social drinkers. Psychological Science.
Kashdan, T.B., Breen, W.E., & Julian, T. (2010). Everyday strivings in combat veterans with posttraumatic stress disorder: Problems arise when avoidance and emotion regulation dominate. Behavior Therapy, 41, 350-363.
King, L. & Raspin, C. (2004). Lost and found possible selves: Subjective well-being, and ego development in divorced women. Journal of Personality 72 (3), 603-632. “Looking longingly upon previously cherished goals may be a source of considerable misery.” p. 603
King, L. (2009). Podcast in the series, A Better You with Coach Caroline.
King, L. A., Scollon, C. K., Ramsey, C. M., & Williams, T. (2000). Stories of life transition: Happy endings, subjective well-being, and ego development in parents of children with Down Syndrome. Journal of Research in Personality, 34, 509–536.
King, L. A., & Hicks, J. A. (2007). Whatever happened to “what might have been”? Regret, happiness, and maturity. American Psychologist, 62, 625-636.
Maymin, S. & Britton, K. (2009). Resilience: How to Navigate Life’s Curves. Positive Psychology News.
Reivich, K, & Shattẻ, A. (2002). The Resilience Factor: 7 Keys to Finding Your Inner Strength and Overcoming Life’s Hurdles. New York: Broadway Books.
Schneider, S. (2001). In search of realistic optimism. Meaning, knowledge, and warm fuzziness. American Psychologist, 6(3):250-63.
Tugade, M. & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to bounce back from
negative emotional experiences. Journal of Personality and Social Psychology, 86 (2), 320–333.
Winwood, P. C., Bakker, A. B. & Winefield, A. H. (2007). An investigation of the role of non–work-time behavior in buffering the effects of work strain. Journal of Occupational and Environmental Medicine, 49, 862-871.
Medicopter courtesy of ER24 EMS (Pty) Ltd
Vipassana Meditation courtesy of h.koppdelaney
Resilience is Social (my title) courtesy of Paul Williams
Working dog courtesy of Lisa Norwood.