Resilience Anita Rosario Webb Ph D JPS Health

Resilience Anita Rosario Webb, Ph. D JPS Health Network Fort Worth, Texas

DEFINITION • Resilience is a personality/character trait. • Ability to “maintain stable equilibrium” • Healthy levels of functioning – Psychological – Physical – (Bonanno 2004)

Definition (continued) • “A dynamic process • “Encompassing positive adaptation • “Within the context of significant adversity. ” – Luthar, Cicchetti, Becker. “The construct of resilience. ” Child Devel. 2000; 71(3): 543 -62.

Defining Factors • Two “critical conditions” – 1. Exposure to • Significant threat or • Severe adversity – 2. Achievement of positive adaptation • Despite major assaults on the developmental process

Beyond Coping • When faced with adversity, do NOT just – “Cope with it” or “Live with it” • “Crisis” = Danger + Opportunity • Seize the opportunity to grow, develop skills. • Become resilient by conquering challenges. – Rutter, M. Psychosocial Resilience and Protective Mechanisms. Am J Orthopsych: 57(3): 316– 331, 1987.

Ordinary and Common • “The great surprise of resiliency research is – “The ordinariness of the phenomenon. ” • “Resilience is common. ” – “Normative function of adaptational systems” • Positive outlook on human development – (Masten 2001)

Historically • Research on schizophrenia • Conclusion: Premorbid social competence was – “Prognostic of relatively resilient trajectories” • Social competence = “Relative competence” with – 1. Work life – 2. Social relations – 3. Marriage – 4. Capacity to fulfill responsibilities

The Children • Children of parents with schizophrenia • Unexpected finding – Many children thrived – Despite high-risk status • Triggered interest in “resilience” research

Resilient Children • Much of the research shows that children – Are more resilient than adults – Able to adopt the concept of resilience – And “make it work” for them. – Are able to apply these strategies to their lives • (Kersting 2003)

Resilience Factors • “A process or phenomenon reflecting positive child adjustment despite conditions of risk. ” • “Protective and vulnerability processes that – “Substantially improve at-risk children’s odds – “Of doing well in life. ” • Identifying: Adversities and “risk modifiers” – (Luthar and Zelazo 2003)

Children: Conclusions • “Resilience is common among children growing up in disadvantaged conditions. ” • Research to identify protective factors for at-risk children found – Multiple pathways – Some unexpected – (Masten 2001)

Parenting • “How a parent responds will teach a child – “How much to worry about a physical symptom – “And what might be an appropriate response. ” • “Repeated patterns of interaction between parent and child can have long term effects – “On the child’s central nervous system, including – “How they physiologically respond to stress. ”

Teach the Children Teach kids at an early age how to be resilient • Have friends and be a friend. • Believe in yourself and what you know you can do. • Take charge of your behavior and actions. • Look at the bright side. • Set new goals and make a plan to reach them. Brochures for kids, teens, parents, teachers (2003) http: //helping. apa. org (American Psychological Association)

Kids and Illness • Cancer survivors, ages 8 -12 • “Many are just as happy and well-adjusted as those who never had the illness. ” • Sometimes even more so: – “I kind of feel guarded by God now. ” – (Sebastian, age 9) – (Bhatia 2005)

Longitudinal Research • Example: Cohort born in Hawaii 1955 – N= 698 prenatal – All had significant adversities in childhood – Poverty, abuse, parent mental illness, parents’ divorce • Findings: Risk, resilience and recovery • Study is ongoing – Werner & Smith (2001): Journeys from childhood to midlife: risk, resilience and recovery. In Goldstein Brooks (2013): Handbook of Resilience in Children.

New Childhood Resource • • Goldstein S and Brooks RB (eds). Handbook of Resilience in Children NY: Springer Science+Business Media, 2013 • (continued)

II. Lifespan Development • The mechanisms operating at • Key turning points in people's lives • Must be given special attention. – Michael Rutter – Psychosocial Resilience and Protective Mechanisms. – American Journal of Orthopsychiatry. – 57(3): 316– 331, July 1987 •

Protective Factors • Positive adjustment despite adversity/risk • Protective factors research • “Risk modifiers” – Behavioral resilience – Mental Health – Prevention – SS Luthar, LB Zelazo. – Research on resilience: an integrative review, 2003.

“Road to Resilience” • Stress Inoculation – Menu of “rather ordinary” behaviors – Can be learned by “most anyone” – Including children • “Resilience Bundle” – Build a personal package of strategies for resilience. – American Psychological Association – http: //helping. apa. org (APA: Newman 2002)

Resilience Tools • Stress Management strategies – Focus on slow, deep breathing – Sing a (non-sad) song – Turn on the radio/TV/etc. – Create/recite a prayer – Recall happy memories – Focus on “happy things” in your life – Take a walk, exercise, dance, etc. – Etc.

Create a “Resilience Bundle” • Example: – Biological strategy • Breathe! – Psychological strategy • Positive self-talk – Social strategy • Laugh with others – Spiritual strategy • Attitude of gratitude

Measuring Resilience • Examples: • Connor and Davidson Resilience Scale – “CD-RISC” – “Stress-coping ability” – 25 items, five factors • Connor (2003) • Resilience Scale in Nursing • (Wagnild & Young 1993)

III. Physicians • • • “Physician Burnout” Result: Rushed and impersonal patient care “This is what's ailing the medical profession today. ” Challenge: Finding Meaning in Medicine By specialty? Karin Evans (2006) http: //greatergood. berkeley. edu/article/item/finding_meaning_in_medicine/#

Stress and Burnout • U. S. physicians – 46% suffer from burnout – Family Med = 51% – Emergency Med = 66% • “Lose the inspiration and meaning” – (Van Dyke & Singer 9/26/12 fmdrl. org) – (Shanafelt et al. Arch Int. Med. Aug. 2012)

Compassion Fatigue • “Hidden crisis in healthcare” – “Recapturing the soul of medicine” – RN Remen. West. J Med 2001 - ncbi. nlm. nih. gov – Institute for the Study of Health and Illness • Danger of developing “de facto compassion” • Response: New medical school curriculum – “The Healer’s Art” – Finding Meaning in Medicine

Teaching Compassion? • “You can’t teach compassion. ” – Charles Garfield, School of Med. , U. C. San Francisco • Instead: “Physicians must open up – “And shed the armor of detachment – “If they are to serve their patients – “And feel personally fulfilled. ” – James s. Gordon MD, Director Center for Mind-Body Medicine, Georgetown University

Teaching Resilience? • “Physicians, heal each other. ” • Medical students work together in small groups – Meditation techniques, self-expression – “Expressing and understanding the personal struggles they will face in school and over their careers” – “Self-care as the foundation for being with others and caring for others. ” – Georgetown Univ. : Center for Mind-Body Medicine

Thriving in Residency • • “Increasing residents’ awareness “As well as their resilience “In maintaining meaning “In their practice of medicine. ” – Medicine and Compassion. – David Shim, Karin Evans. Fall/Winter 2006 -2007 • http: //greatergood. berkeley. edu/article/item/finding_meaning_in_medicine/#

The End – Classic Resource: • M. Rutter. Psychosocial Resilience and Protective Mechanisms. Am J Orthopsychiatry: 57(3): 316– 331, 1987. – Family Medicine: “Finding, keeping and revitalizing the meaning in family medicine”. Dyke and Seger (2012). www. fmdrl. org