Resilience
Translating resilience theory for assessment and application with children, adolescents, and adults: Conceptual issues Information on
Resilience from the American Psychological Association A combination of factors contributes to resilience. Many studies show that the primary factor in resilience is having caring and supportive relationships within and outside the family. Relationships that create love and trust, provide role models and offer encouragement and reassurance help bolster a person's resilience. Several additional factors are associated with resilience, including: 1. The capacity to make realistic
plans and take steps to carry them out. All of these are factors that people can develop in themselves. 10 ways to build resilience 1. Make connections. Good relationships with close family members, friends or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience.mSome people find that being active in civic groups, faith-based organizations, or other local groupsmprovides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper. 2. Avoid seeing crises as insurmountable problems. You can't change the fact that highly stressful events happen, but you can change how you interpret and respond to these events. Try looking beyondthe present to how future circumstances may be a little better. Note any subtle ways in which you mightmalready feel somewhat better as you deal with difficult situations. 3. Accept that change is a part of living. Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter. 4. Move toward your goals. Develop some realistic goals. Do something regularly — even if it seems like a small accomplishment — that enables you to move toward your goals. Instead of focusing on tasks that seem unachievable, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?" 5. Take decisive actions. Act on adverse situations as much as you can. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away. 6. Look for opportunities for self-discovery. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life. 7. Nurture a positive view of yourself. Developing confidence in your ability to solve problems and trusting your instincts helps build resilience. 8. Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion. 9. Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear. 10. Take care of yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience. 11. Additional ways of strengthening resilience may be helpful. For example, some people write about their deepest thoughts and feelings related to trauma or other stressful events in their life. Meditation and spiritual practices help some people build connections and restore hope. The key is to identify ways that are
likely to work well for you as part of your own personal
strategy for fostering The Resilience
Paradox: Why We Often Get Resilience Wrong Researchers, managers, consultants, and psychologists all know that resilience is the most important factor not only to mental health but to performance and success. People who are resilient to adversity, difficulty, and stress quickly rise to the top. They are today's best performers and tomorrows leaders. It is also a lack of resilience which is associated with stress leave, absenteeism, poor performance, and ultimately mental illness. Resilience is pretty much the holy grail of positive human functioning. The big question, then, is how to build resilience. How do everyday people strengthen their capacity to respond well to setbacks, to persist in the face of failure rather than give up, and to cope effectively with stress? This question raises what I refer to as the resilience-paradox. Resilience is characterized by the ability to maintain a positive mindset and keep stress in check when dealing with difficult experiences. Drawing on this perspective, resilience training programs frequently focus on building people’s capacity to maintain positive thoughts and emotions (e.g., gratitude) and promote strategies designed to minimize stress (e.g., mindfulness). Although important, a focus on positivity and stress reduction alone overlooks a critical aspect of how resilience is built. From a neurobiological perspective, reducing stress rather than engaging with it productively does little to promote the capacity to respond effectively to adversity. Even worse, our research shows that placing too much emphasis on the value of remaining positive can lead people to respond poorly to failure and may even contribute to conditions such as depression. This is because messages about the importance of positivity can make people feel like they are failing to be resilient or successful when they feel down, anxious, or stressed. The evidence suggests that resilience does not come from maintaining a Zen-like response to every experience that life throws at us—it is born from being in touch with what it feels like to fail, from understanding the pain of loss, and from an intimate insight into the experience of being overwhelmed and out of our depth. Put simply, resilience is developed through discomfort. That means being exposed to experiences that push us or challenge us in a variety of ways. Why Exposure Is Key In his seminal research, the world-famous psychologist Martin Seligman demonstrated that when animals or humans are exposed to uncontrollable stress, they tend to give up, and this response is maintained even when opportunities to escape from that stress are presented to them later. Referring to this response as learned helplessness, Seligman provided critical insights into the process by which people learn to respond poorly to adversity, and ultimately how mental health issues such as depression unfold. Some years later a lesser-known group of researchers ran a different study. They also exposed rats to a single episode of uncontrolled stress and observed the learned helplessness response that Seligman had earlier reported. In one condition, however, they exposed a group of rats to repeated stress (electric shocks and swims in cold water) for several days prior to running the main experiment. What they found was that this group of rats—the ones who had experienced repeated exposure to stress—were less likely to demonstrate the learned helplessness response. Instead, even after facing uncontrollable stress they did not give up so quickly, and when provided with an opportunity to escape they were more likely to do so. Researchers have identified that enhanced adrenal functioning underpins this increased capacity to respond well to stress. Exposure to adverse or stressful experiences can literally strengthen the body’s capacity to efficiently release adrenaline in response to stress and to quickly return to baseline once the stressful event has passed. This is not dissimilar to a highly trained athlete who can efficiently exert energy but then return to a resting baseline quickly afterward. Of course, athletes do not develop this capacity by avoiding stress—they actively seek it out through training. Challenge vs. Threat Thinking Not all exposure is good. Just think of the many people who become traumatized in response to highly stressful events such as car accidents, war, or even loss. The key is understanding what distinguishes ‘good’ exposure from ‘bad.' When people experience stressful events as threatening, their body tends to release more cortisol. This is not good for health and does not facilitate more effective responding like the efficient release of adrenaline can. Feeling threatened means that we see the demands of the situation as greater than our personal capacities to cope, and it is this imbalance between personal resources and situational demands that can leave people feeling overwhelmed, stressed out and perhaps even traumatized. This is the hallmark of ‘bad’ exposure. In contrast, ‘good’ exposure occurs when people experience stressful events as challenging. That is, they feel that even though the experience requires them to move outside of their comfort zone, they have the resources to cope. It is when people feel challenged that their body builds the kind of increased adrenal capacity referred to above. These experiences also build their confidence in their own abilities, meaning that the next stressful experience is more likely to feel like a challenge than a threat, and the process continues, leading to more resilient responding, increased confidence to seek out challenging experiences in life, and so on. So how can people learn to respond to stressful events as more like a challenge than a threat? The key to this is how we understand the event and also how we understand our personal resources. It is also about understanding the critical role of motivation. Stepping into the Abyss Exposure therapy is about allowing people to face their fears—to be exposed to those things that make them feel threatened. This works because being exposed to what we fear (when it is not actually dangerous, but just uncomfortable) tends to be less noxious than the fear of that thing itself. Research shows that this is the same for physically painful experiences—mostly, it is the fear of pain which is more unpleasant than the experience of pain itself. The best way to overcome fear is to face it head-on. This is because fear or anxiety is not only emotions, they are motivations—they motivate us to escape and get away. When we step towards something which is screaming at us to escape, however, it reinforces a different message in our brain. Rather than reinforcing our fears, by acting on them, we are challenging them by responding differently—by approaching them rather than looking to escape. It is for this reason that, when it comes to dealing with panic attacks, one of the best pieces of advice is to try to have one! If we respond to feelings of panic by approaching those feelings, rather than trying to avoid them, we counteract the emotion at a motivational level. It is perhaps exactly this approach which is desperately needed when rates of Anxiety are increasing globally. 3 Key Principles Required to Promote Challenge Thinking By adopting a challenge mindset, we are not only able to face our fears more effectively, but by doing so we are also providing ourselves with more opportunities to build resilience. We are more likely to step outside of our comfort zones, to tackle new, exciting, but also scary experiences. We are also able to respond to the many obstacles, setbacks, and failures we might face on a day-to-day basis as opportunities for growth, rather than threats to our happiness. Here are three factors that help to promote a challenge mindset when it comes to facing difficult or uncomfortable experiences. Focus on influence rather than control. Uncomfortable experiences often feel that way because they challenge our ability to be in control. Stepping outside of our comfort zone means facing new risks that we might have little control over. A good strategy is to focus on how we might influence these situations, rather than how we can maintain control. This reduces feelings of helplessness. Focus on gains rather than losses. Tackling difficult experiences comes with new risks, and beyond losing our comfort zone for a period of time, we are also exposed to the potential for negative outcomes. Importantly, failing or getting it wrong is not only about loss. We also gain a lot from these experiences. Failure provides an important pathway through which we can connect and bond with others. It is also an important aspect of learning and growth. Build confidence. The best way to build confidence in our capacity to tackle difficult experiences as challenges rather than threats is through experience. The more that we face these experiences, the more confident we are in our own capabilities. It is very difficult to know what we are made of if we don’t test ourselves from time to time References Bastian, B. (2018). The other side of happiness. Penguin, UK. Dejonckheere, E., Bastian, B., Fried, E., Murphy, C., & Kuppens, P. (2017). Perceiving social pressure not to feel negative predicts depressive symptoms in daily life. Depression and Anxiety, 34, 836-844. McGuirk, L., Kuppens, P., Kingston, R., & Bastian, B. (2017). Does a culture of happiness increase rumination over failure? Emotion, 18, 755-764. Maier, S. F., & Seligman, M. E. (1976). Learned helplessness: Theory and evidence. Journal of Experimental Psychology: General, 105, 3-46 Weiss, J. M., Glazer, H. I.,
Pohorecky, L. A., Brick, J. and Miller, N. E. (1975).
Effects of chronic exposure to stressors on avoidance-escape
behavior and on brain norepinephrine. Psychosomatic
Medicine, 37(6), 522–534. The Dark
Side of Resilience In that sense, the best way to develop resilience is through hardship, which various philosophers have pointed out through the years: Seneca noted that “difficulties strengthen the mind, as labor does the body” and Nietzsche famously stated “that which does not kill us, makes us stronger.” In a similar vein, the United States Marine Corps uses the “pain is just weakness leaving the body” mantra as part of their hardcore training program. But could too much resilience be a bad thing, just like too much muscle mass can be a bad thing — i.e., putting a strain on the heart? Large-scale scientific studies suggest that even adaptive competencies become maladaptive if taken to the extreme. As Rob Kaiser’s research on leadership versatility indicates, overused strengths become weaknesses. In line, it is easy to conceive of situations in which individuals could be too resilient for their own sake. For example, extreme resilience could drive people to become overly persistent with unattainable goals. Although we tend to celebrate individuals who aim high or dream big, it is usually more effective to adjust one’s goals to more achievable levels, which means giving up on others. Indeed, scientific reviews show that most people waste an enormous amount of time persisting with unrealistic goals, a phenomenon called the “false hope syndrome.” Even when past behaviors clearly suggest that goals are unlikely to be attained, overconfidence and an unfounded degree of optimism can lead to people wasting energy on pointless tasks. Along the same line, too much resilience could make people overly tolerant of adversity. At work, this can translate into putting up with boring or demoralizing jobs — and particularly bad bosses — for longer than needed. In America, 75% of employees consider their direct line manager the worst part of their job, and 65% would take a pay cut if they could replace their boss with someone else. Yet there is no indication that people actually act on these attitudes, with job tenure remaining stable over the years despite ubiquitous access to career opportunities and the rise of passive recruitment introduced by the digital revolution. Whereas in the realm of dating, technology has made it easier for people to meet someone and begin a new relationship, in the world of work people seemed resigned to their bleak state of affairs. Perhaps if they were less resilient, they would be more likely to improve their job circumstances, as many individuals do when they decide to ditch traditional employment to work for themselves. However, people are much more willing to put up with a bad job (and boss) than a bad relationship. In addition, too much resilience can get in the way of leadership effectiveness and, by extension, team and organizational effectiveness. In a recent study, Adrian Furnham and colleagues showed that there are dramatic differences in people’s ability to adapt to stressful jobs and workplace environments. In the face of seemingly hopeless circumstances, some people resemble a superhero cartoon character that runs through a brick wall: unemotional, fearless, and hyper-phlegmatic. To protect against psychological harm, they deploy quite aggressive coping mechanisms that artificially inflate their egos. Meanwhile, others have a set of underlying propensities that make them act a little differently when under stress and pressure. They become emotionally volatile and scared of rejection. And consequently, they move away from groups, put up walls to avoid being criticized, and openly admit faults as a way to guard against public shaming. Even though the resilient superhero is usually perceived as better, there is a hidden dark side to it: it comes with the exact same traits that inhibit self-awareness and, in turn, the ability to maintain a realistic self-concept, which is pivotal for developing one’s career potential and leadership talent. For instance, multiple studies suggest that bold leaders are unaware of their limitations and overestimate their leadership capabilities and current performance, which leads to not being able to adjust one’s interpersonal approach to fit the context. They are, in effect, rigidly and delusionally resilient and closed off to information that could be imperative in fixing — or at least improving — behavioral weaknesses. In short, when resilience is driven by self-enhancement, success comes at a high price: denial. Along with blinding leaders to improvement opportunities and detaching them from reality, leadership pipelines are corroded with resilient leaders who were nominated as high-potentials but have no genuine talent for leadership. To explain this phenomenon, sociobiologists David Sloan Wilson and E.O. Wilson argue that within any group of people — whether a work team or presidential candidates — the person who wins, and is therefore named the group’s leader, is generally very resilient or “gritty.” However, there is something more important going on in human affairs than internal politics, and competition within groups is less important than between groups — such as Apple going head to head with Microsoft on technological innovations, Coca-Cola trying to outmaneuver Pepsi’s marketing campaigns, or, in evolutionary terms, how our ancestors fought for territory against rival teams 10,000 years ago. As Robert Hogan notes, to get ahead of other groups, individuals must be able to get along with each other within their own group in order to form a team. This always requires leadership, but the right leaders must be chosen. When it comes to deciding which leaders are going to rally the troops in the long-term, the most psychologically resilient individuals have a miscellany of characteristics that come much closer to political savvy and an authoritarian leadership style than those needed to influence a team to work in harmony and focus its attention on outperforming rivals. In other words, choosing resilient leaders is not enough: they must also have integrity and care more about the welfare of their teams than their own personal success. In sum, there is no doubt that resilience is a useful and highly adaptive trait, especially in the face of traumatic events. However, when taken too far, it may focus individuals on impossible goals and make them unnecessarily tolerant of unpleasant or counterproductive circumstances. This reminds us of Voltaire’s Candide, the sarcastic masterpiece that exposes the absurd consequences of extreme optimism: “I have wanted to kill myself a hundred times, but somehow I am still in love with life. This ridiculous weakness is perhaps one of our more stupid melancholy propensities, for is there anything more stupid than to be eager to go on carrying a burden which one would gladly throw away, to loathe one’s very being and yet to hold it fast, to fondle the snake that devours us until it has eaten our hearts away?” Finally, while it may be reassuring
for teams, organizations, and countries to select leaders on
the basis of their resilience — who doesn’t want
to be protected by a tough and strong leader? — such
leaders are not necessarily good for the group, much like
bacteria or parasites are much more problematic when they
are more resistant. Resilience Is
About How You Recharge, Not How You Endure Why should flying deplete us? We’re just sitting there doing nothing. Why can’t we be tougher — more resilient and determined in our work – so we can accomplish all of the goals we set for ourselves? Based on our current research, we have come to realize that the problem is not our hectic schedule or the plane travel itself; the problem comes from a misunderstanding of what it means to be resilient, and the resulting impact of overworking. We often take a militaristic, “tough” approach to resilience and grit. We imagine a Marine slogging through the mud, a boxer going one more round, or a football player picking himself up off the turf for one more play. We believe that the longer we tough it out, the tougher we are, and therefore the more successful we will be. However, this entire conception is scientifically inaccurate. The very lack of a recovery period is dramatically holding back our collective ability to be resilient and successful. Research has found that there is a direct correlation between lack of recovery and increased incidence of health and safety problems. And lack of recovery — whether by disrupting sleep with thoughts of work or having continuous cognitive arousal by watching our phones — is costing our companies $62 billion a year (that’s billion, not million) in lost productivity. And just because work stops, it doesn’t mean we are recovering. We “stop” work sometimes at 5PM, but then we spend the night wrestling with solutions to work problems, talking about our work over dinner, and falling asleep thinking about how much work we’ll do tomorrow. In a study released last month, researchers from Norway found that 7.8% of Norwegians have become workaholics. The scientists cite a definition of “workaholism” as “being overly concerned about work, driven by an uncontrollable work motivation, and investing so much time and effort to work that it impairs other important life areas.” We believe that the number of people who fit that definition includes the majority of American workers, including those who read HBR, which prompted us to begin a study of workaholism in the U.S. Our study will use a large corporate dataset from a major medical company to examine how technology extends our working hours and thus interferes with necessary cognitive recovery, resulting in huge health care costs and turnover costs for employers. The misconception of resilience is often bred from an early age. Parents trying to teach their children resilience might celebrate a high school student staying up until 3AM to finish a science fair project. What a distortion of resilience! A resilient child is a well-rested one. When an exhausted student goes to school, he risks hurting everyone on the road with his impaired driving; he doesn’t have the cognitive resources to do well on his English test; he has lower self-control with his friends; and at home, he is moody with his parents. Overwork and exhaustion are the opposite of resilience. And the bad habits we learn when we’re young only magnify when we hit the workforce. In her excellent book, The Sleep Revolution, Arianna Huffington wrote, “We sacrifice sleep in the name of productivity, but ironically our loss of sleep, despite the extra hours we spend at work, adds up to 11 days of lost productivity per year per worker, or about $2,280.” The key to resilience is trying really hard, then stopping, recovering, and then trying again. This conclusion is based on biology. Homeostasis is a fundamental biological concept describing the ability of the brain to continuously restore and sustain well-being. Positive neuroscientist Brent Furl from Texas A&M University coined the term “homeostatic value” to describe the value that certain actions have for creating equilibrium, and thus wellbeing, in the body. When the body is out of alignment from overworking, we waste a vast amount of mental and physical resources trying to return to balance before we can move forward. As Jim Loehr and Tony Schwartz have written, if you have too much time in the performance zone, you need more time in the recovery zone, otherwise you risk burnout. Mustering your resources to “try hard” requires burning energy in order to overcome your currently low arousal level. This is called upregulation. It also exacerbates exhaustion. Thus the more imbalanced we become due to overworking, the more value there is in activities that allow us to return to a state of balance. The value of a recovery period rises in proportion to the amount of work required of us. So how do we recover and build resilience? Most people assume that if you stop doing a task like answering emails or writing a paper, that your brain will naturally recover, such that when you start again later in the day or the next morning, you’ll have your energy back. But surely everyone reading this has had times where you lie in bed for hours, unable to fall asleep because your brain is thinking about work. If you lie in bed for eight hours, you may have rested, but you can still feel exhausted the next day. That’s because rest and recovery are not the same thing. Stopping does not equal recovering. If you’re trying to build resilience at work, you need adequate internal and external recovery periods. As researchers Zijlstra, Cropley and Rydstedt write in their 2014 paper: “Internal recovery refers to the shorter periods of relaxation that take place within the frames of the workday or the work setting in the form of short scheduled or unscheduled breaks, by shifting attention or changing to other work tasks when the mental or physical resources required for the initial task are temporarily depleted or exhausted. External recovery refers to actions that take place outside of work—e.g. in the free time between the workdays, and during weekends, holidays or vacations.” If after work you lie around on your bed and get riled up by political commentary on your phone or get stressed thinking about decisions about how to renovate your home, your brain has not received a break from high mental arousal states. Our brains need a rest as much as our bodies do. If you really want to build resilience, you can start by strategically stopping. Give yourself the resources to be tough by creating internal and external recovery periods. In her upcoming book The Future of Happiness, based on her work at Yale Business School, Amy Blankson describes how to strategically stop during the day by using technology to control overworking. She suggests downloading the Instant or Moment apps to see how many times you turn on your phone each day. The average person turns on their phone 150 times every day. If every distraction took only 1 minute (which would be seriously optimistic), that would account for 2.5 hours of every day. You can use apps like Offtime or Unplugged to create tech free zones by strategically scheduling automatic airplane modes. In addition, you can take a cognitive break every 90 minutes to recharge your batteries. Try to not have lunch at your desk, but instead spend time outside or with your friends — not talking about work. Take all of your paid time off, which not only gives you recovery periods, but raises your productivity and likelihood of promotion. As for us, we’ve started using
our plane time as a work-free zone, and thus time to dip
into the recovery phase. The results have been fantastic. We
are usually tired already by the time we get on a plane, and
the cramped space and spotty internet connection make work
more challenging. Now, instead of swimming upstream, we
relax, meditate, sleep, watch movies, journal, or listen to
entertaining podcasts. And when we get off the plane,
instead of being depleted, we feel rejuvenated and ready to
return to the performance zone. What's wrong
with resilience? 2 It seems like everyone, and every organisation, wants to become more resilient at the moment. When I’m asked to talk about, and train people, on building resiliency, I find that I’m often starting at a disadvantage. The ideas that people have about what resilience means - at least from a scientific perspective - are often both mistaken and fixed. The common misconception about resilience is that it is the ability to remain strong, stoic and defiant in the face of challenge and adversity. A, perhaps simplistic, metaphor that could be used to describe this way of thinking is a lighthouse. It stands tall, strong and defiant in the face of crashing waves and stormy weather. We know that this ‘heroic’ approach to dealing with stress and challenge is, for most of us, not sustainable. Overtime, our energy and resistance levels fade until we reach breaking point, crumble and burn out. Whilst this is not a universal understanding of resiliency, it can be difficult to challenge and change people’s ideas and mindsets surrounding this concept. Rather than battle these pre-conceptions, I’ve started to change the conversation instead. I’m using a different perspective. I encourage people, teams and organisations to think about being more buoy(ant). Buoy(ant) wellbeing Rather than resist or deflect waves, a buoy moves with them. In stormy weather it gets buffeted more than when it is calm, but the buoy never gets swept away. This stability is achieved because it is tethered to, and grounded by, an anchor. In order to maintain buoyancy and stability from both a mental and physical health and wellbeing perspective it is important to have an effective anchor too. Buoy(ant) wellbeing - moving with, but not getting swept away by, challenges and opportunities Buoy(ant) wellbeing - moving with, but not getting swept away by, challenges and opportunities Whilst our natural levels of buoyancy and the weight of our personal anchors are unique to us, they are not fixed. We can all pro-actively influence our ability to move with, but not get swept away by, the challenges and opportunities we face each day.
The ability of our personal anchors to keep us grounded is influenced by our day-to-day actions, behaviours, values and beliefs. These are skills, practices and ways of thinking that can be learned, nurtured and developed. And these concepts can be applied holistically to organisations, as they can to teams and individuals. Ultimately, the most critical element in positively influencing actions and discussions around health and wellbeing is not myths, metaphors or models. It’s the business of encouraging and enabling people, at all levels, to make the changes and take the steps that are going to make the biggest difference to their own health and the wellbeing of others. This often starts, but should never stop, with training or education. We need to bring evidence-based approaches to make positive sustainable and systematic change. It’s not a case of stopping resiliency training. Or that ‘buoyancy is best’. But words do matter. Our mindsets and beliefs around
concepts and ideas influence how we engage and explore
them. What’s wrong
with resilience - Journal of Research in
Nursing My apprehension about this kind of event, where different viewpoints on apparently the same topic are discussed, is that the differences, both small and large, can get oddly overlooked as each person hears the same uttered words in a slightly different way. And resilience has got to be one of those ‘empty signifiers’ marshalled for all kinds of purposes and causes. In its common usage among healthcare workers at the moment I think it is often a term that supports the status quo. It can leave staff who might be traumatised by organisational failures feeling personally responsible for those failures. I knew this was true in theory. Testimony from the audience that evening gave us some shocking examples of its operation in practice. My main argument, to put it in a nutshell, is that resilience at the moment is a fad that has been taken up by many groups (we were there to look at it in nursing) superficially without a proper understanding of where it came from or what has been left out from the original concept. When you look at writing about resilience in nursing, it is overwhelmingly submissive. It is dominated by phrases like ‘roll with the punches’ or ‘helping the nurse to survive at the bedside for longer’. Papers encouraging nurses to be resilient always start the same way – ‘you can’t often choose what happens to you but you can choose how you react’. So, the largest clinical workforce in the UK (and most countries) with its 450,000-strong trade unionhas given up on influencing what ‘happens to it’ to use this passive phrase. Instead, the nurse promoters of resilience are telling the workforce to develop optimism, or a sense of humour; to bounce back or roll with the punches. Of course, their intention is good but what they end up doing is urging nurses to acquiesce, to support the status quo. I have never seen any paper about resilience claim that resilience is the basis for activism and change. The promotion of resilience is a purely individualistic attempt to mitigate systemic problems. Individual nurses are basically being asked to take responsibility for political decisions and systematic failures. The promotion of resilience covers over more complex and disturbing issues for the individual and organisations. You could say that this is one reason why it is so popular. The individual is left to deal with issues themselves when developing so-called ‘resilience’ fails to help them. The organisation gets off the hook but never solves its basic problems. So where did this idea of resilience first gain popularity – at least in its current form? It was child psychologists working from the 1980s onwards who were puzzled by their observation that some children from tough backgrounds appeared to succumb to their origins, while others seemed to thrive and escape its harmful influence. They first talked about ‘invulnerable’ children (Anthony and Cohler, 1987), but soon swapped this awkward label for the term ‘resilient’. Their model was that protective factors modified the impact of adversity on children. And these protective factors could be operating at the neighbourhood, school, family or individual level. Actions aimed at improving resilience tended to be community focused. In fact, early researchers in the field had the prescience to warn that the concept of resilience could be misused by policy-makers as an excuse to withdraw services and encourage the socially disadvantaged to simply shape up. Then, as psychologists brought their characteristic methodology and techniques of individual measurement to bear on the topic, an approach emerged in which the communal dimensions of investigations into resilience were dropped. Many researchers focused purely on the attempt to measure this mysterious resilience by means of the psychological questionnaires that we are all familiar with. Personally, I think there must be something seductive as well as more convenient in calculating Cronbach alphas and other statistics compared with trying to understand the messy world of social forces and interactions. We can see that ‘pop-psychology’ has taken up this individualistic approach with a proliferation of websites and papers urging us to learn some resilience skills. The next problematic move comes with the adoption of resilience in nursing research. Nurse researchers, in almost every piece of writing I have seen, understand resilience in purely individual – individualistic – terms. They hand out questionnaires to nurses to measure their levels of resilience, saying sometimes that this could help managers ‘target’ resilience training. None to my knowledge has attempted to assess whole organisations or units for resilient characteristics. It is not far-fetched to think that a resilient healthcare provider would be one with built-in capacities and procedures that enable the maintenance of safe staffing levels, even when a particular unit is short of staff due, for example, to sickness. To imagine, as some do, a resilient organisation as one in which managers touch each other on the arm, make eye contact and talk about ‘taking care of yourself’ is the result of being unable to conceive of resilience as anything other than a personal characteristic or behaviour. Many nurse researchers seem unaware of the history and the complexity of earlier resilience studies. Definitions of resilience in this literature rely heavily on other research written by nurses and perpetuate a partial understanding of the term. They repeat in the introduction to their studies the unempowering mantra of resilience: ‘you can’t often choose 6 Journal of Research in Nursing 23(1) what happens to you but you can choose how you react’. Paradoxically, at the same time as configuring the individual as one who bears responsibility to ‘cope’, they seem uninterested in talking to the individual to find out what adversity or protective factors mean to them with their unique history. Even worse – and this is the crucial point of my argument – they mix up and fail to distinguish between two entirely different sources of ‘adversity’ for nurses. The first source you could say is intrinsic to the work itself: dealing with the suffering of patients and their families, with the effects of extreme illness or mental distress. The second is the adversity that is the result of political decisions, under-resourcing, poor management, dysfunctional and insecure organisations, disempowered nurse managers, sexism, racism in the workplace, which all result in understaffing, perhaps, and high turnover. The first category of adversity you might say comes with the work, and nurses have to develop ways of dealing with it. The second clearly does not and is the result, usually I would argue, of more or less deliberate decisions by politicians and policy-makers pushing the envelope, to put it crudely, of what they can get away with. And then this second type of adversity intensifies the effect of the first type as nurses become less able to properly address the needs of the increasing number of patients they are required to care for. Nurses who go on resilience courses or who urge others to do so, with the best of motives I am sure, are simply playing into the hands of those who do not understand or perhaps value nursing work. And what is worse, they perpetuate a contemporary mindset that promotes the individual bearing responsibility for situations that are the making of others. Many see this tendency as a feature of neo-liberal ideology that has dominated governments since the late 1970s. The possibility of collective activity – resistance, challenge, systemic change – simply fades out of consciousness. Faced with the kind of pressure I have just mentioned, I think it better for nurses, better for the NHS and better for its patients in the long run that nurses resist rather than acquiesce. And I want to end this editorial with some ideas about exactly how they y might do this. ‘Critical resilience’ So, what is the alternative to this individualistic and basically submissive form of resilience? I put forward something to you that we could call ‘critical resilience’. I have just written a book about it (Traynor, 2017) in which I spell it out in more detail. Critical resilience is about understanding: understanding ourselves and our experiences in relation to our society – to take a phrase from feminist consciousness-raising groups (Chicago Women’s Liberation Union, 1970). The combination of becoming informed about the political and policy forces acting on day-to-day working life with frank, mutually supportive discussion can develop critical resilience. Neither on its own is enough. Getting informed by reading a radical nursing blog on health policy or on the latest Nursing and Midwifery Council (NMC) initiative, for example, is just the starting point for responding. And discussion without information can too easily turn into complaint, where the pleasure is not in the creative energy released by analysis and planning to do something, but in simply repeating expressions of suffering. Critique is a practice that demands a rigorous engagement with its object. It is also productive because it can lead to action. I suggested to nurses present yesterday and suggest to readers today that we explore the possibility of setting up groups with fellow students or colleagues to develop informed critiques about aspects of working life. These could be place-based or asynchronous – a nice word to describe social media and web-based discussion forums that are present even for nurses who are isolated for a variety of reasons. Becoming an active member of the RCN or other trade union is, clearly, a good move. Getting together and getting informed
are the first steps in developing critical resilience. The
Construct of Resilience: A Critical Evaluation and
Guidelines for Future Work This paper presents a critical appraisal of resilience, a construct connoting the maintenance of positive adaptation by individuals despite experiences of significant adversity. As empirical research on resilience has burgeoned in recent years, criticisms have been levied at work in this area. These critiques have generally focused on ambiguities in definitions and central terminology; heterogeneity in risks experienced and competence achieved by individuals viewed as resilient; instability of the phenomenon of resilience; and concerns regarding the usefulness of resilience as a theoretical construct. We address each identified criticism in turn, proposing solutions for those we view as legitimate and clarifying misunderstandings surrounding those we believe to be less valid. We conclude that work on resilience possesses substantial potential for augmenting the understanding of processes affecting at-risk individuals. Realization of the potential embodied by this construct, however, will remain constrained without continued scientific attention to some of the serious conceptual and methodological pitfalls that have been noted by skeptics and proponents alike. Introduction Resilience refers to a dynamic process encompassing positive adaptation within the context of significant adversity. Implicit within this notion are two critical conditions: (1) exposure to significant threat or severe adversity; and (2) the achievement of positive adaptation despite major assaults on the developmental process (Garmezy, 1990; Luthar & Zigler, 1991; Masten, Best, & Garmezy, 1990; Rutter, 1990; Werner & Smith, 1982, 1992). In this article, we strive to critically evaluate the resilience literature, an exercise spurred by the recent proliferation of research on this construct along with growing scientific concerns about this body of work. Following the publication of early writings by major systematizers in the field (see, e.g., Anthony, 1974; Garmezy, 1971, 1974; Murphy & Moriarty, 1976; Rutter, 1979; Werner, Bierman, & French, 1971; Werner & Smith, 1982), scholarly interest in resilience has surged (see, e.g., Cicchetti & Garmezy, 1993; Glantz & Johnson, 1999; Wang, Haertel, & Wahlberg, 1994). This burgeoning attention has been paralleled by growing concerns about the rigor of theory and research in the area (e.g., Cicchetti & Garmezy, 1993; Luthar, 1993; Luthar & Cushing, 1999), misgivings which have sometimes culminated in assertions that overall, this is a construct of dubious scientific value (see, e.g., Gordon & Wang, 1994; Kaplan, 1999; Liddle, 1994; Tarter & Vanyukov, 1999; Tolan, 1996). The continued pursuit of research on resilience and the diversity of criticisms levied against the construct conjointly emphasize the value of carefully appraising the various concerns that have been articulated. We begin this paper with a brief historical overview of the construct of resilience, from its inception to its portrayal in current psychological inquiry. We then consider major concerns that have been raised about this construct, which generally fall into four broad categories: (1) ambiguities in definitions and terminology, (2) variations in interdomain functioning and risk experiences among ostensibly resilient children, (3) instability in the phenomenon of resilience, and (4) theoretical concerns, including questions about the utility of resilience as a scientific construct. Within each of these areas, we address the identified criticisms, and, where legitimate, propose solutions for redressing problems that have been noted. Whenever we disagree with criticisms, we strive to elucidate factors that may have contributed to a misunderstanding of the issues. By addressing the valid concerns, clarifying misconceptions, and proposing recommendations for future work, we seek to enhance the quality of scientific investigations and theoretical conceptualizations on resilience in the context of adversity. Historical Context The investigation of factors that result in adaptive outcomes in the presence of adversity has a long and illustrious history, with the empirical literature on schizophrenia constituting a salient founding base (Masten et al., 1990). Early investigations of severely disordered patients were focused primarily on understanding maladaptive behavior, and the subset of patients who showed relatively adaptive patterns were considered atypical and afforded little attention. By the 1970s, researchers had discovered that schizophrenics with the least severe courses of illness were characterized by a premorbid history of relative competence at work, social relations, marriage, and capacity to fulfill responsibility (Garmezy, 1970; Zigler & Glick, 1986). Although resilience was not part of the descriptive picture of these atypical schizophrenics, these aspects of premorbid social competence might be viewed today as prognostic of relatively resilient trajectories. In parallel fashion, studies of children of schizophrenic mothers played a crucial role in the emergence of childhood resilience as a major theoretical and empirical topic (Garmezy, 1974; Garmezy & Streitman, 1974; Masten et al., 1990). Evidence that many of these children thrived despite their high-risk status led to increasing empirical efforts to understand individual variations in response to adversity. Following Emmy Werner's groundbreaking studies on children in Hawaii (Werner et al., 1971; Werner & Smith, 1977), research on resilience expanded to include multiple adverse conditions such as socioeconomic disadvantage and associated risks (Garmezy, 1991, 1995; Rutter, 1979; Werner & Smith, 1982, 1992), parental mental illness (Masten & Coatsworth, 1995, 1998), maltreatment (Beeghly & Cicchetti, 1994; Cicchetti & Rogosch, 1997; Cicchetti, Rogosch, Lynch, & Holt, 1993; Moran & Eckenrode, 1992), urban poverty and community violence (Luthar, 1999; Richters & Martinez, 1993), chronic illness (Wells & Schwebel, 1987), and catastrophic life events (O'Dougherty-Wright, Masten, Northwood, & Hubbard, 1997). The thrust of this research was a systematic search for protective forces, that is, those which differentiated children with healthy adaptation profiles from those who were comparatively less well adjusted. Early efforts were primarily focused on personal qualities of “resilient children,” such as autonomy or high self-esteem (see Masten & Garmezy, 1985). As work in the area evolved, however, researchers increasingly acknowledged that resilience may often derive from factors external to the child. Subsequent research led to the delineation of three sets of factors implicated in the development of resilience: (1) attributes of the children themselves, (2) aspects of their families, and (3) characteristics of their wider social environments (Masten & Garmezy, 1985; Werner & Smith, 1982, 1992). During the last two decades, the focus of empirical work also has shifted away from identifying protective factors to understanding underlying protective processes. Rather than simply studying which child, family, and environmental factors are involved in resilience, researchers are increasingly striving to understand how such factors may contribute to positive outcomes (Cowen et al., 1997; Luthar, 1999). Such attention to underlying mechanisms is viewed as essential for advancing theory and research in the field, as well as for designing appropriate prevention and intervention strategies for individuals facing adversity (Cicchetti & Toth, 1991, 1992; Luthar, 1993; Masten et al., 1990; Rutter, 1990). Finally, conceptions of resilience as absolute or global, as opposed to relative or circumscribed, also have changed over the years. In some early writings, those who did well despite multiple risks were labeled “invulnerable” (Anthony, 1974). This term was misleading because it implied that risk evasion was absolute and unchanging. As research evolved, it became clear that positive adaptation despite exposure to adversity involves a developmental progression, such that new vulnerabilities and/or strengths often emerge with changing life circumstances (Masten & Garmezy, 1985; Werner & Smith, 1982). Thus, the term “resilient,” which more accurately describes the relative as opposed to fixed nature of the concept, came to encompass those once referred to as “invulnerable.” The Construct of Resilience: Scientific Concerns and Challenges In the following discussion, we address, in turn, various issues that have been singled out as potentially problematic aspects of the construct of resilience. We proffer explicit suggestions for redressing the valid concerns that have impeded progress in this field, and elucidate factors that might underlie those criticisms we believe are less well justified. Variations in Definitions and Use of Terminology 1. The theoretical and research literature on resilience reflects little consensus about definitions, with substantial variations in operationalization and measurement of key constructs Without question, resilience is variously defined in extant theoretical writings. Rutter (1987, 1990), for example, has characterized resilience as the positive end of the distribution of developmental outcomes among individuals at high risk. Masten and her colleagues (Masten, 1994; Masten et al., 1990) have distinguished among three groups of resilient phenomena: those where (1) at-risk individuals show better-than-expected outcomes, (2) positive adaptation is maintained despite the occurrence of stressful experiences, and (3) there is a good recovery from trauma. In empirical research, similarly, approaches taken to operationalizing resilience have varied across laboratories (see, e.g., Cicchetti & Garmezy, 1993; Gordon & Song, 1994; Kaufman, Cook, Arny, Jones, & Pittinsky, 1994; Luthar & Cushing, 1999; Stouthamer-Loeber et al., 1993; Tarter & Vanyukov, 1999; Tolan, 1996). To illustrate, adversity conditions examined have ranged from single stressful life experiences—such as exposure to war—to aggregates across multiple negative events (e.g., by means of life event checklists). Similarly, there has been substantial diversity in defining positive adjustment among individuals at risk. Some researchers have stipulated that to qualify for labels of resilience, at-risk children must excel in multiple adjustment domains (e.g., Tolan, 1996), whereas others have required excellence in one salient sphere with at least average performance in other areas (Luthar, 1991; Luthar, Doernberger, & Zigler, 1993; see also Egeland & Farber, 1987; Radke-Yarrow & Sherman, 1990). Resilience researchers have also conceptualized the connection between conditions of risk and manifest competence differently. Some have used personbased data analytic approaches, which entail identifying individuals with high adversity and high competence, and comparing them with others (e.g., low adversity, high competence). Other investigators have used variable-based analyses and relied on either main effect models or those involving interaction effects (see Luthar & Cushing, 1999, for a detailed review of measurement issues). This diversity in measurement has led some scholars to question whether resilience researchers are dealing with the same entity or with fundamentally different phenomena (Kaplan, 1999). Although diverse empirical methods can admittedly lead to a medley of unrelated findings, it must be noted, too, that some variability in methods is essential to expand understanding of any scientific construct (Luthar, 1996). Consider, as an analogous case, the vast literature on parent–child relations. If one were told of new research evidence on “predictors of adequate parenting,” a number of questions would inevitably arise, including, “Adequate parenting in terms of which dimensions? Parental attitudes or parental behaviors? If the latter, is the reference to nurturance, discipline, communication styles, or some combination of these? What ethnic group is involved, and who are the respondents?” Depending on the answers to each of these queries, the conclusions deriving from the research could differ substantially. Returning to the controversy under consideration, it is clearly untenable to argue that the diversity in defining or measuring positive parenting, in itself, diminishes the literature on this construct. To the contrary, this very diversity is essential for establishing the validity of discrete parenting domains. If different studies with diverse methods yielded largely consonant findings on particular aspects of parenting, it would be reasonable to infer that they each tapped into the same broad scientific construct (cf. Cronbach & Meehl, 1955). Considering such evidence of construct validity for the existence of a hypothetical concept (Carnap, 1950; Meehl, 1977; Pap, 1953), research in the area of resilience appears to be in good standing. Reviews of the relatively small though burgeoning literature (see, e.g., Cicchetti & Garmezy, 1993; Luthar & Zigler, 1991; Masten et al., 1990; Masten & Coatsworth, 1995, 1998; Rutter, 1990; Werner, 1990, 1995) have indicated synchronous evidence regarding many correlates of resilience (protective factors) across multiple studies that have used varying measurement strategies. Themes that recur across studies include the importance of close relations with supportive adults, effective schools, and connections with competent, prosocial adults in the wider community. This said, we believe that in future research, concerted attention must be given both to selecting and justifying strategies used to operationalize pivotal constructs. Definitional diversity can result not only in varying conclusions regarding risk and protective processes but also in disparate estimates of rates of resilience among similar risk groups (Cicchetti & Rogosch, 1997; Kaufman et al., 1994; Luthar & Cushing, 1999). In the absence of any universally employed operationalization of resilience, researchers must clearly explicate the approaches they select to define both adversity and competence and provide cogent justifications for choices made on both conceptual and empirical grounds (also see discussions later in this article on the multidimensional nature of resilience). Furthermore, as empirical evidence on resilience accumulates, scholars need to consolidate findings periodically, identifying themes that recur across methodologically diverse studies as opposed to those identified in relatively few instances (cf. Luthar, 1999). Such diversity is essential in allowing the derivation of testable theoretical postulates that imply breadth of applicability across disparate at-risk samples and methods, as opposed to those that suggest relative specificity in application. 2. Discrepancies also exist in conceptualizations of resilience as a personal trait versus a dynamic process. Researchers use the term interchangeably to refer to each of these Confusion regarding the issue of trait versus process derives, in part, from the influential literature on ego-resiliency, a construct developed by Jeanne and Jack Block (1980) that refers to a personal characteristic of the individual. Ego resiliency encompasses a set of traits reflecting general resourcefulness and sturdiness of character, and flexibility of functioning in response to varying environmental circumstances. Illustrative descriptors on the California Q-sort measure (Block, 1969) include, “engaged with the world but not subservient to it,” and “integrated performance under stress.” Although adversity of some kind actually may have been experienced by a child labeled as ego-resilient, by definition, one cannot necessarily assume that this is true. In contrast, when the term resilience is used to refer to a process, the experience of significant adversity is a given. Thus, the terms ego-resiliency and resilience differ on two major dimensions (Luthar, 1996). Ego-resiliency is a personality characteristic of the individual, whereas resilience is a dynamic developmental process.1 Second, ego-resiliency does not presuppose exposure to substantial adversity, whereas resilience, by definition, does. Commenting on issues of terminology, Masten (1994) recommended that the term resilience be used exclusively when referring to the maintenance of positive adjustment under challenging life conditions. Masten cautioned against the use of the term “resiliency” in such situations because this term carries the connotation of a personality trait. Any scientific representation of resilience as a personal attribute can inadvertently pave the way for perceptions that some individuals simply do not “have what it takes” to overcome adversity. Besides being misinformed and unwarranted, such perspectives do little to illuminate processes underlying resilience or to guide the design of appropriate interventions (Masten et al., 1990; Reynolds, 1998; Tarter & Vanyukov, 1999). Additional confusion between process versus trait may derive from the occasional use of the term “resilient children,” even by scholars who conceptualize resilience as a dynamic process (e.g., Masten et al., 1990; Rutter, 1993; Werner, 1984). Note, however, that the phrase “resilient children” does not imply reference to a discrete personal attribute, akin to intelligence or empathy. Rather, it is used to refer to the two coexisting conditions of resilience—the presence of threat to a given child's well-being and evidence of positive adaptation in this child, despite the adversity encountered (cf. Richters & Weintraub, 1990; see also Luthar, 1993; Luthar & Cushing, 1999). Allusions to resilient youth are thus most accurately interpreted as implying a two-dimensional characterization that encompasses aspects of children's life circumstances (as might terms such as “impoverished” or “maltreated” children), and evidence of positive adaptation among these children, across one or more domains of functioning. In future research efforts, it is imperative that investigators exercise caution in their use of terminology, with clear indication when their work is focused on a process and not a personality trait. We concur with and underscore Masten's (1994) recommendation that competence despite adversity be referred to by the term “resilience” and never “resiliency,” which carries the misleading connotation of a discrete personal attribute. 3. There also is little consensus around central terms used within models of resilience. Researchers use terms such as “protective” or “vulnerability” factors in varied and inconsistent ways Undoubtedly, this is a problem: A range of inconsistencies has been noted in the use of pivotal terms (Luthar, 1993; Luthar & Cushing, 1999). In the earliest and most cogent descriptions of models of resilience (Garmezy, Masten, & Tellegen, 1984; Masten et al., 1988; Rutter, 1987), the term “protective” was reserved for effects involving interactions, wherein individuals with a particular attribute, but not those without it, were relatively unaffected by high versus low levels of adversity. By contrast, several researchers use the term “protective” to refer to direct ameliorative effects. In Werner and Smith's research (1982, 1992), for example, protective variables were simply those that distinguished high-functioning children at risk from those who developed serious problems. Similar usage of the term is evident in reports from the Rochester Child Resilience Project (Cowen, Work, & Wyman, 1997; Parker, Cowen, Work & Wyman, 1990; Wyman, Cowen, Work, & Kerley, 1993; Wyman, Cowen, Work, & Parker, 1991). Enduring confusion around the term “protective factors” is also reflected in literature reviews, in which the term is used interchangeably to discuss main effects models and those involving interactive processes (see Haggerty, Sherrod, Garmezy, & Rutter, 1994; Luthar & Zigler, 1991; Rolf, Masten, Cicchetti, Nuechterlein, & Weintraub, 1990). To reduce the equivocality in connotations of central terms in resilience research, Luthar (1993) has argued for the incorporation of more differentiated terms to label salient processes. Attributes with direct ameliorative effects—operating at both high- and low-risk conditions (see Figure 1A)—might simply be labeled “protective” as they are by many contemporary investigators. Such direct effects may be distinguished from interactive or moderating processes by using more specific labels for the latter, such as “protective-stabilizing” (when the attribute in question confers stability in competence despite increasing risk, Figure 1B); “protective-enhancing” (when it allows children to “engage” with stress such that their competence is augmented with increasing risk, Figure 1C); or “protective but reactive” (when the attribute generally confers advantages but less so when stress levels are high than low, Figure 1D). (See here.) Similar suffixes can be employed for findings on vulnerability effects, that is, those where individuals with the attribute manifest greater maladjustment, overall, than those without it. To illustrate, “vulnerable-stable” could describe findings where the general disadvantage of individuals with the attribute remained stable despite changing levels of stress (Figure 1E) and “vulnerable and reactive” when the overall disadvantage linked with the attribute was heightened with increasing levels of stress (Figure 1F). In future research, it would be useful to strive for greater congruence between the intuitive connotations of central terms and the patterns to which they are used to refer. The terms “protective” and “vulnerability” process might be used when overall effects on at-risk children's adjustment are positive versus negative in direction, respectively. Main effects can be distinguished from the more complex interactive processes through the use of more elaborated labels for the latter, which simultaneously indicate both the existence and directionality of interactive processes in resilience. In closing our discussion on this issue, we reiterate that the need for greater precision in terminology goes well beyond issues of semantics (Luthar, 1993). All sciences are built upon classifications that structure their domains of inquiry. Although resilience has been increasingly recognized as a distinct domain of inquiry (Cicchetti, 1989, 1993; Masten et al., 1990), its continued vitality and impact necessitate concerted efforts to reach consensus on pivotal terms within major models (Rolf & Johnson, 1990; Rutter, 1990). Achieving this goal is essential for the ultimate derivation of operational criteria which can be interpreted unambiguously by the array of scientists and clinicians who pursue work in this area (Seifer, 1995). The Multidimensional Nature of Resilience 1. The multidimensional nature of resilience, exemplified by findings that some high-risk children manifest competence in some domains but exhibit problems in other areas, has led some scientists to question the veridicality of the construct At-risk children who are labeled as resilient on the basis of particular competence criteria can reflect considerable heterogeneity in functioning across other adjustment domains. Among children with histories of maltreatment, for example, Kaufman et al. (1994) found that almost two thirds were academically resilient, yet only 21% manifested resilience in the domain of social competence. Similarly, studies have shown that among adolescents who experienced significant adversities, those who overtly reflect successful adaptation often struggle with covert psychological difficulties, such as problems of depression and posttraumatic stress disorder (see, e.g., Luthar, 1991; Luthar et al., 1993; O'Dougherty-Wright et al., 1997). Evidence of such variations across domains has led some scientists to question whether resilience is a veridical construct as opposed to a mythical entity (Fischer et al., 1987; Liddle, 1994; Tolan, 1996). In studies of resilience, we believe that there should undoubtedly be some uniformity across theoretically similar adjustment domains, but not across those that are conceptually distinct (Luthar, 1996, 1998). Thus, for example, if a subset of at-risk children seem resilient on the basis of high academic grades, then they should also reflect positive adaptation on persevering classroom behaviors as perceived by others. On the other hand, it is unrealistic to except any group of individuals to exhibit consistently positive or negative adjustment across multiple domains that are conceptually unrelated, for even trajectories of “normally” developing children do not reflect a uniform progression of diverse cognitive, behavioral, and emotional capacities (e.g., Fischer, 1980; Fischer & Bidell, 1998). Unevenness in functioning across domains is a common occurrence in the process of ontogenesis (Cicchetti, 1993; Cicchetti & Toth, 1998a), such that a range of developmental outcomes is inevitably constructed within normal, abnormal, and resilient trajectories. Whereas evidence of uneven functioning across different domains does not in itself invalidate resilience as a construct, it does carry a critical message for researchers—the need for specificity in discussing resilient outcomes is pressing. In describing their findings, investigators must specify the particular spheres to which their data apply and must clarify that success in these domains by no means implies positive adaptation across all important areas (Cicchetti & Garmezy, 1993; Luthar, 1993). Encouragingly, researchers are increasingly using circumscribed terms such as “educational resilience” (Wang et al., 1994), “emotional resilience” (Kline & Short, 1991), and “behavioral resilience” (Carpentieri, Mulhern, Douglas, Hanna, & Fairdough, 1993), thereby bringing greater precision to terminology commonly used in the literature. 2. Inclusion of diverse adaptation domains, and evidence of inconsistencies across these, also greatly complicates the process of delineating “optimal” indicators of resilience within individual studies Recognizing the notion of multifinality in developmental processes (Cicchetti & Rogosch, 1996), resilience researchers typically consider multiple theoretically important domains in operationalizing “positive adaptation.” A common strategy is to include several stage-salient tasks on which, if successful, the child would be viewed as having met societal expectations associated with that life stage (Cicchetti & Schneider-Rosen, 1986; Havighurst, 1952; Masten & Coatsworth, 1998; Sroufe & Rutter, 1984). Among at-risk toddlers, for example, indicators of resilience might include behaviors reflecting secure attachments to their caregivers and the development of an autonomous self (Sroufe, Egeland, & Kreutzer, 1990). For school-age children, appropriate indicators would be academic success and positive relationships with peers as well as adults (Masten et al., 1995). When multiple outcomes are assessed, a critical question to be considered is whether these should be examined separately or somehow integrated, and decisions in this regard must be based on the conceptual distinctness of the domains in question. If the outcomes assessed represent largely discrete constructs, it is best to examine them separately. To illustrate, there is accumulating evidence that among innercity youth, resilience as indexed by conventionally conforming behaviors (e.g., academic striving) may have little to do with resilience as indicated by peer acceptance; in point of fact, the two may sometimes run counter to each other (Coie & Jacobs, 1993; Luthar, 1995; Luthar & McMahon, 1996; Seidman, Allen, Aber, Mitchell, & Feinman, 1994). In such instances, it is most meaningful to examine vulnerability and protective processes separately for major outcomes and to discuss findings in terms of the particular domain under consideration. A related question that arises when multiple outcomes are considered separately is whether some of these should be accorded more importance than others as the most “critical” indicators of resilience. Again, researchers' decisions must be guided by the nature of the risk under study. In situations where the adversity condition confers particularly high risk for some important outcomes, giving these priority over others is logical (Luthar, 1993). To illustrate, in the case of adolescents at high familial risk for antisocial personality disorder, socially conforming behaviors might be targeted as a primary domain. Evidence of their scholastic excellence (although undoubtedly important) would be comparatively less central in ascertaining the degree to which major risks were overcome. Among those at risk for developing a mood disorder, the primary focus might be on the achievement of emotional self-regulation and the evasion of significant internalizing problems (Cicchetti & Toth, 1998b). Again, whether the child is among the most popular students in the class would be comparatively lower on the hierarchy of outcomes in identifying resilient trajectories. In many instances, however, no single area may be more likely than others to be affected by the risk in question. If this is so, multiple outcomes—all conceptually critical—can be accorded equivalent salience and either considered separately or integrated into a composite, if doing this is theoretically justified. The latter strategy is exemplified in the Zigler–Phillips Social Competence Index (Zigler & Glick, 1986), which involves composites based on several theoretically interlinked areas of adult functioning including occupational, educational, and marital history. Composite constructs such as these have also been profitably examined in research on childhood resilience, with incorporation of multimethod, multiinformant strategies of assessment (e.g., Pianta, Egeland, & Sroufe, 1990; Richters & Martinez, 1993). A final question with regard to competence criteria is whether labels of resilience should necessitate excellent versus average levels of competence, and here yet again, choices must be conceptually guided by the nature of the risk studied. When the stressor entails severe to catastrophic events (e.g., see Gest, Reed, & Masten, 1999; Masten et al., 1999), the maintenance of near-average functioning should suffice. On the other hand, when risks experienced generally fall in the more moderate range (e.g., see Luthar, 1991), evidence of superior functioning in conceptually important domains may be required to justify labels of resilience. In summary, there is undoubtedly an array of possible ways to define positive adaptation when studying resilience. Conceptual considerations must guide decisions regarding whether (1) some outcome domains are given priority over others, (2) multiple domains are combined or considered separately, and (3) criteria for resilience stipulate excellent versus adequate functioning. In future research, it is vital that resilience investigators ensure high fidelity between the theoretical underpinnings of their work and the specific criteria they select to operationalize “successful adaptation” within particular at-risk samples. The Robustness of Evidence on Resilience 1. The construct of resilience presupposes exposure to significant risks. Given uncertainties in risk measurement, however, it is difficult to determine whether, in a given study, all individuals viewed as resilient experienced comparable levels of adversity Two salient issues have been raised in this regard: (1) the concept of statistical risk versus actual risk (Richters & Weintraub, 1990); and (2) subjective versus “objective” ratings of risk (Bartlett, 1994; Gordon & Song, 1994). Concerns regarding statistical versus actual risk stem from the widespread practice in resilience research of treating a particular index as reflecting adversity if it shows significant statistical associations with child maladjustment (Masten et al., 1990; Richters & Weintraub, 1990). Even in instances where overall correlations have been established between exposure to the risk and poor outcomes among children, questions remain about the specific life circumstances of different individuals in a particular sample (Cicchetti & Garmezy, 1993; Kaplan, 1999; Masten, 1994). Interpretive dilemmas in this regard are illustrated by using research findings on children of drug abusers, a group at high statistical risk for psychopathology. Among offspring of mothers addicted to cocaine or opioids, 65% of the children have been found to have a major psychiatric disorder (Luthar, Cushing, Merikangas, & Rounsaville, 1998). Although the 35% of disorder-free children might be seen as “resilient,” it is possible too that their family milieus were relatively healthy, as a result, for example, of high support from extended family (e.g., Rutter, 1990). Suggestions such as these lead to questions of whether all children in ostensibly high-risk contexts are really at risk, or, alternatively, whether some well-functioning children may not be resilient at all but may actually have faced low proximal risk (Baldwin, Baldwin, & Cole, 1990; Richters & Weintraub, 1990). Individual differences in proximal processes do not necessarily invalidate resilience research that is based on global or distal risk indices (Luthar, 1993; Luthar & Cushing, 1999). Returning to the previously noted findings on addicts' offspring, the 65%–35% split indicates that considering a delimited risk factor—parental drug abuse—the odds are about six in ten that a particular child will develop a psychiatric disorder. Admittedly, an unusually well-functioning mother in one family, or the presence of a nurturing grandparent in another, may buffer the child against the risk. This, however, is precisely what the search for protective factors is about, that is, the location of a set of processes that distinguish a substantial proportion of the healthy children from the maladjusted ones (Gest, Neemann, Hubbard, Masten, & Tellegen, 1993). Therefore, whereas the label “resilient” may sometimes be more appropriate for protective families than the healthy children within them (see Baldwin et al., 1990), the fact remains that because the likelihood is high that drug abusers' children will develop psychopathology, there is value in examining what differentiates relatively well-functioning youth from those who fare less positively. Probabilistic evidence on global risks also serves the useful function of directing the scientific study of salient risk mechanisms. Even though risk markers themselves do not cause negative outcomes, they are valuable in terms of signaling potential processes that do causally affect outcomes (Cichetti & Rogosch, in press; O'Connor & Rutter, 1996). Knowledge that particular risk factors are linked with high probability of maladjustment has spawned several productive efforts to elucidate proximal processes or mechanisms by which distal risk factors confer vulnerability on affected children (e.g., Baldwin et al., 1993; Cicchetti & Lynch, 1993; Richters & Martinez, 1993). Regarding the issue of subjective perceptions of risk in resilience research, Gordon and Song (1994) note that the meaning of a particular adverse event to the individual experiencing it can differ substantially from that of the resilience researcher (Bartlett, 1994). Some individuals may see themselves as being relatively well off, even though scientists may define their life circumstances as being highly stressful. Concerns about subjective ratings are ubiquitous in psychological research and are not unique to studies of resilience. For example, substantial evidence suggests that ratings of parent–child relationships, or of peer relationships, vary considerably depending on whose reports they are based on: a parent's, the target child's, or an “objective” observer's (Achenbach, McConaughy, & Howell, 1987; Hart, Lahey, Loeber, & Hanson, 1994; Kazdin, 1990; Reynolds & Graves, 1989; Rothbaum & Weisz, 1994; Weisz et al., 1988). Moreover, it is clear that none of these reports necessarily captures “the truth” any more than do others. In fact, there are usually important lessons to be learned by contrasting findings based on different raters (Achenbach, 1993; Voelker, Shore, Hakim-Larson, & Bruner, 1997). Also relevant vis-à-vis concerns about subjective perceptions is the capacity of “objectively determined” risk status in itself to allow the identification of salient protective factors (O'Connor and Rutter, 1996). If most children perceived a specific event as noxious but a subset subjectively perceived it as relatively neutral, data for the second group could be critical in illuminating protective forces. Once again, the researchers' task would be to determine why these youngsters differed from the norm in perceiving the event as benign. Were they generally more optimistic than others, for example, as a result of easygoing temperaments? Alternatively, did religious faith help them feel buffered from the adversity they had experienced? In summary, uncertainties regarding proximal risks in the lives of individual children, or dissonance between children's subjective perceptions and “objective” ratings, do not automatically fault resilience research that is based on probabilistic associations involving risk indices. Once researchers have determined that the odds of maladjustment are high in the presence of a certain risk, it is entirely logical—indeed, worthwhile—to try to determine the factors associated with relatively positive child outcomes, as well as to examine the proximal processes by which the distal risk marker confers vulnerability on affected groups of children. 2. Research findings on resilience may often be unstable. Statistical findings obtained from the tails of continua are always unstable because they involve smaller numbers, and in the case of resilience, researchers deal with not one but two tails of continua — that is, high adversity and high competence Two major issues must be considered in weighing concerns about the instability of statistical findings on resilience (see Fisher et al., 1987; Gordon, Rollock, & Miller, 1990; Kaufman et al., 1994; Tolan, 1996). First, the number of individuals one is dealing with depends in large part on the criteria used to define high adversity and high competence in a particular study (Cicchetti & Rogosch, 1997; Fischer et al., 1987). If relatively stringent criteria are used (e.g., plus one standard deviation on both adversity and competence), then, admittedly, the researcher can end up with a small number of resilient individuals (see Luthar & Cushing, 1999). On the other hand, when competence criteria are operationalized less stringently—and appropriately so, when dealing with extremely harsh life adversities (cf. Gest et al., 1999)—the number of resilient children in a particular sample could be far from trivial (Cicchetti & Rogosch, 1997). Consider, for example, an investigation involving 100 adolescent offspring of drug abusing parents, many of whom experience exposure to rampant crime and violence in their neighborhoods, chronic poverty, and, often, serious parental psychopathology. For these youngsters, an appropriate criterion for positive outcomes (resilience) might simply be the evasion of serious externalizing psychopathology. If this criterion were used, then one could expect at least half the sample to be classified as resilient on the basis of evidence that by midadolescence, less than 40% of addicted mothers' children have developed lifetime diagnoses of either oppositional defiant or conduct disorders (e.g., Luthar & Cushing, 1998; Luthar et al., 1998). Even assuming, for the moment, that only a small number of children will meet the stipulated criteria for resilience, this in itself cannot negate the value of studying the construct. Myriad examples in the literature reflect years of productive scientific effort focused on groups that are, in any absolute terms, small in size (e.g., autism, Down syndrome, manic depressive illness, physical abuse, schizophrenia, and so on). Thus, limits in absolute numbers, per se, do not provide a strong rationale for concluding that resilience is a construct unworthy of scientific study. Previously noted issues presuppose person-based analytic approaches; the alternative strategy—where resilience is viewed as a continuous variable—presents a different set of complications with regard to instability in research results. As indicated earlier, studies using variable-based approaches rely on either main effect or interaction effect associations to detect protective factors. When findings rest on main effect associations, they can be relatively robust, with effect sizes for individual protective factors being as high as 10%–20% (Conrad & Hammen, 1993; Garmezy et al., 1994; Luthar, 1991; Morison & Masten, 1991; Pellegrini, Masten, Garmezy, & Ferrarese, 1987; Wyman et al., 1993). However, when studies require interaction effects to infer a protective or “buffering” process in resilience, effect sizes are small (often 2%–5%) and the findings, consequently, tend to be unstable (Luthar, 1993). This fact has led many researchers to caution against undue reliance on interaction effects in trying to understand factors linked with resilience (Luthar & Cushing, 1999; Rutter, 1983; Wertlieb, Weigel, & Feldstein, 1989). Although interaction effect models capture a conceptually interesting subgroup of resilience phenomena, these more complicated models are open to several difficulties linked with statistical testing. In summary, research findings on resilience are not inevitably unstable because they involve small samples. In any study, the number of individuals classified as resilient will depend on the criteria used to define high stress and high competence. Moreover, a low frequency of occurrence should not disqualify any phenomenon from being the focus of scientific inquiry. In variable-based research in which resilience is rated as a continuum, main-effect findings of protective influences are likely to be more robust than are the often more conceptually intriguing ones involving interactive effects. 3. There can be considerable ontogenetic instability in the phenomenon of resilience, for individuals at high risk rarely maintain consistently positive adjustment over the long term Some researchers have argued that resilience is of tenuous scientific utility because this phenomenon reflects ontogenetic instability. Although some at-risk children excel at a particular point in time, many falter subsequently and manifest substantial deterioration in their levels of adaptation (Coie et al., 1993; Kaplan, 1999; Tarter & Vanyukov, 1999; Tolan, 1996). There is no question that all individuals—resilient or otherwise—show fluctuations over time within particular adjustment domains. However, there is increasing evidence that, overall, at-risk children who excel in critical domains continue to reflect generally positive adaptational profiles over time. Werner's (1994, 1995) longitudinal research has shown that across a period of over 30 years, most children who were labeled as resilient maintained high functioning in everyday life. Egeland, Carlson, & Sroufe (1993) have shown that among at-risk children, positive adaptation during infancy and toddlerhood is related to competent functioning during the elementary school years. Cowen et al. (1997) found stability in adjustment levels in highly stressed inner-city children, even in the face of continued stress over a period of 1 to 2 years. More recently, Masten and colleagues (1999) presented evidence on longitudinal pathways to resilience from childhood to late adolescence. Results of these diverse investigations indicate that resilience is not necessarily a transient or ephemeral phenomenon (Luthar, 1998) This collective evidence notwithstanding, it must be emphasized that empirical attentiveness to ontogenetic fluctuations is critical, for resilience is clearly not a static state (Cicchetti et al., 1993; Coie et al., 1993; Egeland et al., 1993). As Garmezy (1990) has emphasized, short- and long-term longitudinal research on resilience provides critical opportunities to record changes in life-span developmental pathways—including the emergence of new vulnerabilities, strengths, or both at each period of the life course—which permits further validation of the dynamic nature of the construct of resilience (Gest et al., 1993; Rutter, 1990). Optimally, such studies should include measurement of all competence domains investigated on at least three or more occasions, with assessments spaced far enough in time to enable the hypothesized protective factors to exert their effects. Furthermore, such studies should be designed such that they permit the use of both person-oriented and variable-oriented statistical procedures, as these approaches often yield substantively different sets of insights and conclusions (Bergman & Magnusson, 1997; Cicchetti & Rogosch, 1996; Luthar & Cushing, 1999). Theoretical Concerns 1. Progress in the area of resilience will remain seriously constrained as long as studies remain largely empirically driven as opposed to theoretically based, with little conceptual recognition of the importance of multiple contexts in children's development We concur with Rigsby's (1994, p. 91) assertion that accumulation of “… more correlates of resilience and failure will not be helpful if it is done outside the context of serious theory building in human development.” We likewise agree with Kaplan (1999, p. 75) that a powerful theoretical framework would be one that consists “… of variables that are distantly related to the outcome, variables that are the result of those distantly related variables and that are more closely related to the outcomes, and variables that moderate the effects of the variables that are more distally or proximally related to the outcome variable of interest.” At the same time, we do not believe that existing studies on resilience have inadequate bases in theory or that they lack conceptual recognition of transactions involving contexts of development (see Kaplan, 1999; Tolan, 1996). In point of fact, three major frameworks have guided much of the extant research, common across which are emphases on multiple levels of influence on the children's adjustment and on reciprocal associations among these diverse influences and the child's adjustment status across different spheres. The first of these guiding perspectives is that identified by Garmezy (1985) and Werner and Smith (1982, 1992), in which salient protective and vulnerability processes affecting at-risk children are viewed as operating at three broad levels. These include influences at the level of the community (e.g., neighborhoods and social supports), the family (e.g., parental warmth or maltreatment), and the child (e.g., traits such as intelligence or social skillfulness). This triarchic framework has served to organize much research on resilience (e.g., Cowen et al., 1997; Fergusson, Horwood, & Lynskey, 1994; Fergusson & Lynskey, 1996; Luthar, 1999; Masten et al., 1988; Seifer, Sameroff, Baldwin, & Baldwin, 1992; Wyman et al., 1991). A second set of guiding perspectives consists of those focused on transactions between the ecological context and the developing child, such as Bronfenbrenner's (1977) ecological theory, Sameroff and Chandler's (1975) transactional perspective, and Cicchetti and Lynch's (1993) integrative ecological-transactional model of development. In the ecological-transactional model, contexts (such as culture, neighborhood, family) are conceptualized as consisting of a number of nested levels varying in proximity to the individual. These levels transact with each other over time in shaping ontogenic development and adaptation. Such theoretical accounts, in which contextual surrounds and transactional interchanges are emphasized, have formed the conceptual bases for resilience research involving diverse risks including family poverty, experiences of maltreatment, and others (Baldwin et al., 1993; Cicchetti & Lynch, 1993; Cicchetti et al., 1993; Connell, Spencer, & Aber, 1994; Crittenden, 1985; Leadbeder & Bishop, 1994). A third pertinent theory is the structural-organizational perspective (Cicchetti & Schneider-Rosen, 1986; Sroufe, 1979), central to which is the belief that there are generally continuity and coherence in the unfolding of competence over time. Although distal historical factors and current influences are both viewed as important to the process of development, active individual choice and self-organization are believed to exert critical influences on development (Cicchetti & Tucker, 1994). Again, a number of resilience researchers have adopted the organizational perspective as their guiding theoretical approach (e.g., Cicchetti & Rogosch, 1997; Cicchetti et al., 1993; Egeland et al., 1993; Egeland & Farber, 1987; Luthar, 1995; Luthar & Suchman, 2000; Gest et al., 1993; Masten et al., 1995, 1999; Wyman et al., 1993). The preceding discussions might elicit objections among some that the theories enumerated are not unique to resilience; although clearly true, we do not view this issue as constituting a problem. Many fundamental developmental processes operate in similar ways among low- and high-risk children (Graham & Hoehn, 1995; Graham & Hudley, 1994; Luthar, 1999), so that attempting to derive theories that would apply only to “poor children” or at-risk families is unnecessary (or even unwise; Garcia Coll et al., 1996). What is critical, on the other hand, is that when broad developmental theories are brought to bear in resilience research, they are specifically expanded to consider features that are prominent within the particular adversity circumstance under study (Luthar, 1999). Such theory-extension efforts are well exemplified in an integrative model for studying minority youth, presented by Garcia-Coll et al. (1996). Anchored within social stratification theory, this model posits that eight major constructs affect the development of minority children: social position variables (e.g., race, gender); racism and discrimination; segregation (residential and psychological); promoting/inhibiting environments (e.g., school and health care); adaptive culture (traditions and legacies); child characteristics such as age or temperament; family values and beliefs; and children's developmental competencies. The attractiveness of this model lies both in the centrality accorded to several constructs that are salient in and often unique to the lives of minority youth, as well as in the clear specification of paths of influence, which in turn yields theoretical hypotheses amenable to testing in research. In sum, future empirical studies on resilience must be presented within cogent theoretical frameworks. Additionally, when existing developmental theories are applied in studying resilience, there needs to be explicit conceptual consideration of how interrelations among the matrix of constructs examined may be affected by the nature of the specific adversity condition under study. 2. Some scholars who advocate for scientific parsimony contend that the notion of resilience adds nothing to the more general term “positive adjustment” and argue that the focus on resilience does not augment developmental theory Although we concur that resilience and the broader construct of positive adjustment overlap (see, e.g., Tarter & Vanyukov, 1999), we believe that there is considerable value in retaining resilience as a distinct construct. The notion of resilience represents a helpful heuristic in developmental science, for it provides a framework for thinking about development that differs from many classical theories (Luthar, 1996). Through specifying the achievement of positive adjustment in the face of significant adversity, resilience encapsulates the view that adaptation can occur through trajectories that defy “normative” expectations (cf. Cicchetti, 1996). A second reason for retaining the conceptual distinctiveness of resilience lies in evidence that positive adjustment patterns occurring with, versus without, conditions of adversity often have different correlates and thus reflect distinct constructs (Luthar, 1998, 1999). Several studies have indicated varying antecedents of resilience as compared with positive adjustment in general (cf. Rutter, 1990). To illustrate, Dubois and colleagues found that the salutary effects of support from school staff were more pronounced among poor youth than others, which suggests that for children facing multiple adversities, the relative dearth of positive experiences outside school may render those that occur within school even more salient (DuBois, Felner, Brand, Adan, & Evans, 1992; DuBois, Felner, Meares, & Krier, 1994). Similarly, differing antecedents of resilience have been found among maltreated versus nonmaltreated disadvantaged children (Cicchetti & Rogosch, 1997). Relationship factors were significant predictors among the latter but not the former, which probably reflects the relative salience of seriously disturbed parent–child relationships in the lives of the maltreated youngsters (Cicchetti & Toth, 1995). The preceding illustrations presume interactive effects in resilience research; however, how should main effect findings on protective factors be handled? If high- and low-risk groups were each helped by informal social supports, for example (see Dubow & Tisak, 1989; Pryor-Brown & Cowen, 1989; Sandler & Barrera, 1984), should this evidence not be viewed as a subset of data on general positive adjustment, rather than as a subset of evidence on resilience? Whereas discussing such findings as correlates of “positive adjustment” may be scientifically parsimonious in some ways, retaining resilience as a distinct notion serves parsimony in other respects: Doing so excludes from consideration a sizable body of evidence of questionable relevance. Most existing evidence on developmental processes is based on work with middle-class, white samples (Graham, 1992; Spencer, 1988). Some of these results may be of little relevance for investigators interested in resilience, for many forces that are powerful in benign life circumstances can lose their relative salience in the context of serious external stressors. To illustrate, maternal perceptions of behavior problems in children seem to affect the parenting behaviors of mothers low on socioeconomic disadvantage, but not those of chronically disadvantaged mothers. Among the latter, the (frequently high) levels of life stress and personal distress they experience seem to be far more potent in affecting the quality of their parenting (Dumas & Wekerle, 1995). As relevant research accumulates over time, it is certainly possible that pathways to “resilience” and “positive adjustment” will be judged to be more similar than different; yet recent findings suggest that assuming such congruence at this time would be premature. For example, there is a growing body of evidence that Baumrind's typology of parenting does not operate among the poor as it does among the middle class (see Luthar, 1999 for a review). Rather than democratic, authoritative behaviors, the behaviors most adaptive in inner cities are often those reflecting high strictness and monitoring of children. Similarly, success at some of the classic developmental tasks of adolescence—e.g., doing well academically and getting along with peers—are not necessarily mutually facilitative but can be mutually inhibitory within the setting of the poor urban neighborhood (Luthar, 1999). Turning to the question of whether resilience research can contribute to developmental theory, we see substantial potential in this regard. A cardinal tenet of the rapidly growing field of developmental psychopathology is that the study of the normal and the atypical are mutually beneficial (Cicchetti, 1989, 1993; Sroufe & Rutter, 1984). Understanding processes contributing to positive adjustment under conditions of adversity can help to broaden the understanding of developmental processes that may not be evident in “good enough” normative environments. Further, understanding cases that do not succumb to the negative outcome engendered by a risk process can be critical in expanding our understanding of how the risk process functions. In recent years, several scholars have explicated ways in which their studies of diverse atypical trajectories have led to expanded theories of “normal” human development (see Cicchetti & Cohen, 1995; Luthar, Burack, Cicchetti, & Weisz, 1997). In summary, we believe that at this point in the ontogenesis of developmental research, retaining distinctions between resilience as opposed to positive outcomes in general is important. Discrete scientific categories help to direct inquiry toward relevant domains, and findings on positive outcomes occurring in the absence of known environmental stressors—although potentially useful heuristically—cannot always be assumed to generalize to processes in resilience among individuals facing adversities. Additionally, we believe that the continued study of resilient trajectories carries substantial potential for ongoing refinements of existing theories of normal human development. Future Directions and Conclusions In consolidating directions for future research on resilience, we first briefly summarize those that derived from our preceding review of criticisms of the construct. Following this summary, we present some additional directions for work in the area, which pertain to the scientific exploration of underlying processes; the use of multidisciplinary research designs; and the interface between intervention studies and efforts to understand processes in resilience. Directions Stemming from Extant Criticisms Clarity and consistency in the use of definitions and terminology All scientific reports must include precise statements of the criteria used to operationalize resilience, that is, the specific methods employed to measure both competence and adversity. With the accumulation of empirical findings over time, there is a need for periodic scholarly integration of evidence on protective processes, with a consolidation of those that inhere across diverse approaches to operationalizing risk and competence versus those largely unique to particular groups or research designs. The term “resilience” should always be used when referring to the process or phenomenon of competence despite adversity, with the term “resiliency” used only when referring to a specific personality trait. In describing processes that alter the effects of adversity, the terms “protective” and “vulnerability” should be used to describe overall effects that are beneficial versus detrimental, with more elaborated labels (e.g., with suffixes to these two primary terms) employed to label different interactive processes in resilience. Cognizance of the multidimensional nature of resilience Evidence that at-risk children excel within particular adjustment domains should never obscure the possibility of significant problems within other spheres. Investigators must avoid overly global statements while describing their findings, limiting their conclusions to the precise domains in which resilience is manifested. The selection of specific competence criteria to operationalize resilience within particular studies must always be conceptually driven. The nature of adversity examined and developmental theory should conjointly guide researchers' decisions about the most relevant domains and degrees of competence, as well as the value of combining diverse adaptational domains versus examining them individually. Attention to issues of stability and conceptual coherence Within any given study, the stability of statistical findings on resilience will vary according to the criteria used to define both risk and competence as well as the relationship between these. When findings on resilience are based on a small number of children and on interactive (rather than main) effect models, possible limits to the stability of findings must be clearly stated. Short- and long-term longitudinal studies on resilience are critical because resilience is a dynamic developmental construct. Longitudinal studies must investigate not only the stability of resilience over time, but also the ability of formerly resilient individuals to “bounce back” after difficult periods, to achieving earlier resilient adaptation. Theoretical considerations Resilience researchers must present their studies within a clearly delineated theoretical framework within which hypotheses about salient vulnerability and protective processes are considered vis-à-vis the specific adversity under study. Investigators should also elucidate theoretical postulates that derive from their own findings, when considered collectively with other related results, to use fully guide future inquiry in the area. Wherever possible, lessons gleaned for understanding normal developmental processes should be clearly articulated. Additional Considerations for Future Research Exploration of processes underlying protective/vulnerability factors Research on resilience must accelerate its move from a focus on description to a focus on elucidating developmental process questions. With accumulated evidence that a particular variable does affect competence levels within a specific at-risk group, investigators need to focus their inquiry on understanding the mechanisms by which such protection (or vulnerability) might be conferred. Concretely, such efforts can be explored by examining the degree to which various mechanisms might mediate the effects of a given “protective factor.” Once scientists have accumulated evidence that certain constructs are reliably linked with positive outcomes among particular at-risk groups, potential mechanisms would need to be delineated on the basis of prior empirical and theoretical evidence. For example, if religious faith were the protective factor in question, possible underlying mechanisms might include (1) increases in informal supports, and (2) reductions in dysfunctional coping patterns (e.g., alcohol use) for negotiating everyday stressors (Brody, Stoneman, & Flor, 1996; Luthar, 1999). The relative importance of each hypothesized mediator could then be statistically examined by means of processes outlined by Baron and Kenny (1986), which essentially involve determining the degree to which associations between antecedent (protective) and outcome variables are attenuated after considering shared variance between these and the hypothesized mediators. The importance of integrative, multidisciplinary research For the field of resilience to grow in ways commensurate with the complexity inherent to the construct, efforts to understand underlying processes will be facilitated with the increased implementation of multidisciplinary research designed within a developmental psychopathology framework. Research of this nature entails a consideration of psychological, social, and biological/genetic processes from which varied pathways to resilience might eventuate (equifinality), as well as those that result in diverse outcomes among at-risk individuals (multifinality). Notably lacking in existing research on resilience is attention to the role of biology. Not only do biological factors affect psychological processes, but in addition, psychological experiences can modify brain structure and functioning (Cicchetti & Tucker, 1994; Eisenberg, 1995; Nelson & Bloom, 1997). The role of biological factors in resilience is also suggested by evidence on neural, neuroendocrine, and immune system functions in relation to stress reactivity (Maier & Watkins, 1998; McEwen & Stellar, 1993), and in behavior–genetic research on nonshared environment effects (Plomin, Rende, & Rutter, 1991; Rende & Plomin, 1993). There also is value in cross-disciplinary research integrating insights from developmental psychology with expertise from anthropology, sociology, and cultural psychology. Such research can substantially augment our understanding of context-specific protective and vulnerability processes in child development, that is, those relatively unique to particular subcultural groups (Luthar, 1999). Finally, there is value in research on resilience at different points in human development. Most existing research in this area has been focused on children. Yet resilience can be achieved at any point in the life cycle (cf. Cicchetti & Tucker, 1994; Luthar, 1999), and there is a need for additional work on at-risk individuals' achievement of positive outcomes in later life (cf. Rutter, 1993; Schulz & Heckhausen, 1996; Staudinger, Marsiske, & Baltes, 1993, 1995). Interface between research and interventions Much can be gained by greater interface between “pure” research on protective processes and the application of accumulated knowledge to deriving interventions. Research-based understanding of resilience can allow practitioners to capitalize on periods of developmental change as unique opportunities for promoting positive adaptation (Cicchetti, 1993; Cicchetti & Toth, 1992). In recent years, developmental psychopathologists have increasingly begun to harness research findings on resilience in designing interventions for diverse at-risk groups (e.g., Cowen et al., 1997; Egeland & Erickson, 1990; Luthar & Suchman, 2000). In future efforts, there also is a need for greater attentiveness to the bidirectional nature of links between the pursuit of knowledge on protective processes in resilience and intervention efforts to foster these. Prevention research can be conceptualized as true experiments in altering the course of development (Cicchetti & Toth, 1992; Kellam & Rebok, 1992), thereby offering opportunities to test extant developmental theories as well as insights into the etiology and course of adaptational outcomes (e.g., by verifying the importance of postulated “protective processes”). Conclusions This critique of research on resilience has led us to two broad conclusions. First, we believe that despite many challenges linked with studying this complex construct, the continuation of scientific work in this area is of substantial value. Important advances have been made in understanding resilience over the past few decades, and the continued investigation of risk and protective processes carries much potential to expand developmental theory and to suggest useful avenues for intervention. In short, we disagree with global negative judgments on resilience, such as, “resilience may have served its purpose and may be permitted to retire from the field gracefully and with honor” (Kaplan, 1999, p. 109, original manuscript), or “(This) is not a very useful term for studies of development of children and for related intervention and policy efforts” (Tolan, 1996, p. 13). Our second conclusion, in some ways, constitutes a significant caveat to the first, that is, there is clearly a need for resilience researchers to enhance the scientific rigor of their work. As Kitcher (1985) has noted, standards of evidence and of self-scrutiny must be extremely high whenever scientific claims bear on matters of social policy. We believe that the field of resilience owes a substantial debt to those scholars who have articulated concerns about the construct, for their critiques have drawn attention to many important issues that warrant serious consideration in future scientific efforts. Current controversies surrounding
resilience are reminiscent of concerns that have been voiced
about many other psychological constructs (see Pedhazur
& Schmelkin, 1991), particularly those connoting a
promise for redressing human suffering or social inequities
(cf. Cowen, 1994). Discussing a somewhat similar notion,
Sarason (1993, p. 260) cautioned, “Empowerment has
become a fashionable word. It has the ring of virtue and
unquestioned morality…. If the empowerment movement is
to avoid the worse excesses of sloganeering and conceptual
superficiality, it will have to come to grips with issues
that are as complex conceptually as they are at the level of
action.” The inherent apprehension, as Cowen (1994) has
cautioned, is that the eminent good sense of concepts such
as empowerment—and resilience—may come to outpace
their scientific bases in rigorous empirical and theoretical
efforts. The
Problem with Resiliene Before the word ‘resilience’ achieved common usage, and its current prominent space on the buzz word bingo board of healthcare, I understood it broadly to be inversely related to the degree of vulnerability conferred by a combination of genetic heritage (see Goldberg & Goodyer)- which influences our temperament, personality and susceptibility to some types of mental health problems, early life experiences and social learning in childhood. If a group of people are exposed to the same degree and type of stresses most will cope, they will demonstrate resilience, but a minority will not. We all have differing degrees of it. Some will develop common mental health problems like depression and anxiety in response to traumatic events, and others less common ones, such as psychosis, but many others will get through relatively unscathed. The General Medical Council (GMC) with whom I am still registered, although I no longer practice psychiatry, has recently decided that the current generation of doctors is less resilient than those in the past and students need to undergo resilience training in order to be tough enough for the job. I have a number of problems with this view:
We all differ in our ability to deal with traumatic events and the stress of work, yet within that spectrum of abilities lies the potential for us to learn to listen, support and care for each other: as friends, colleagues, some managers and a insightful and proactive occupational health service did for me; supporting me through my sometimes difficult career. My memoir about experiencing
depression during my career in psychiatry is out now:
The
Other Side of Silence: A Psychiatrist’s Memoir of
Depression ‘published by
Summersdale. Building
your resilience - American Psychological
Association Imagine you’re going to take a raft trip down a river. Along with slow water and shallows, your map shows that you will encounter unavoidable rapids and turns. How would you make sure you can safely cross the rough waters and handle any unexpected problems that come from the challenge? Perhaps you would enlist the support of more experienced rafters as you plan your route or rely on the companionship of trusted friends along the way. Maybe you would pack an extra life jacket or consider using a stronger raft. With the right tools and supports in place, one thing is sure: You will not only make it through the challenges of your river adventure. You will also emerge a more confident and courageous rafter. What is resilience? Life may not come with a map, but everyone will experience twists and turns, from everyday challenges to traumatic events with more lasting impact, like the death of a loved one, a life-altering accident, or a serious illness. Each change affects people differently, bringing a unique flood of thoughts, strong emotions and uncertainty. Yet people generally adapt well over time to life-changing situations and stressful situations—in part thanks to resilience. Psychologists define resilience as the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress—such as family and relationship problems, serious health problems, or workplace and financial stressors. As much as resilience involves “bouncing back” from these difficult experiences, it can also involve profound personal growth. While these adverse events, much like rough river waters, are certainly painful and difficult, they don’t have to determine the outcome of your life. There are many aspects of your life you can control, modify, and grow with. That’s the role of resilience. Becoming more resilient not only helps you get through difficult circumstances, it also empowers you to grow and even improve your life along the way. What resilience isn’t Being resilient doesn’t mean that a person won’t experience difficulty or distress. People who have suffered major adversity or trauma in their lives commonly experience emotional pain and stress. In fact, the road to resilience is likely to involve considerable emotional distress. While certain factors might make some individuals more resilient than others, resilience isn’t necessarily a personality trait that only some people possess. On the contrary, resilience involves behaviors, thoughts, and actions that anyone can learn and develop. The ability to learn resilience is one reason research has shown that resilience is ordinary, not extraordinary. One example is the response of many Americans to the September 11, 2001 terrorist attacks and individuals’ efforts to rebuild their lives after tragedy. Like building a muscle, increasing your resilience takes time and intentionality. Focusing on four core components—connection, wellness, healthy thinking, and meaning—can empower you to withstand and learn from difficult and traumatic experiences. To increase your capacity for resilience to weather—and grow from—the difficulties, use these strategies. Build your connections Prioritize relationships. Connecting with empathetic and understanding people can remind you that you’re not alone in the midst of difficulties. Focus on finding trustworthy and compassionate individuals who validate your feelings, which will support the skill of resilience. The pain of traumatic events can lead some people to isolate themselves, but it’s important to accept help and support from those who care about you. Whether you go on a weekly date night with your spouse or plan a lunch out with a friend, try to prioritize genuinely connecting with people who care about you. Join a group. Along with one-on-one relationships, some people find that being active in civic groups, faith-based communities, or other local organizations provides social support and can help you reclaim hope. Research groups in your area that could offer you support and a sense of purpose or joy when you need it. Foster wellness Take care of your body. Self-care may be a popular buzzword, but it’s also a legitimate practice for mental health and building resilience. That’s because stress is just as much physical as it is emotional. Promoting positive lifestyle factors like proper nutrition, ample sleep, hydration, and regular exercise can strengthen your body to adapt to stress and reduce the toll of emotions like anxiety or depression. Practice mindfulness. Mindful journaling, yoga, and other spiritual practices like prayer or meditation can also help people build connections and restore hope, which can prime them to deal with situations that require resilience. When you journal, meditate, or pray, ruminate on positive aspects of your life and recall the things you’re grateful for, even during personal trials. Avoid negative outlets. It may be tempting to mask your pain with alcohol, drugs, or other substances, but that’s like putting a bandage on a deep wound. Focus instead on giving your body resources to manage stress, rather than seeking to eliminate the feeling of stress altogether. Find purpose Help others. Whether you volunteer with a local homeless shelter or simply support a friend in their own time of need, you can garner a sense of purpose, foster self-worth, connect with other people, and tangibly help others, all of which can empower you to grow in resilience. Be proactive. It’s helpful to acknowledge and accept your emotions during hard times, but it’s also important to help you foster self-discovery by asking yourself, “What can I do about a problem in my life?” If the problems seem too big to tackle, break them down into manageable pieces. For example, if you got laid off at work, you may not be able to convince your boss it was a mistake to let you go. But you can spend an hour each day developing your top strengths or working on your resume. Taking initiative will remind you that you can muster motivation and purpose even during stressful periods of your life, increasing the likelihood that you’ll rise up during painful times again. Move toward your goals. Develop some realistic goals and do something regularly—even if it seems like a small accomplishment—that enables you to move toward the things you want to accomplish. Instead of focusing on tasks that seem unachievable, ask yourself, “What’s one thing I know I can accomplish today that helps me move in the direction I want to go?” For example, if you’re struggling with the loss of a loved one and you want to move forward, you could join a grief support group in your area. Look for opportunities for self-discovery. People often find that they have grown in some respect as a result of a struggle. For example, after a tragedy or hardship, people have reported better relationships and a greater sense of strength, even while feeling vulnerable. That can increase their sense of self-worth and heighten their appreciation for life. Embrace healthy thoughts Keep things in perspective. How you think can play a significant part in how you feel—and how resilient you are when faced with obstacles. Try to identify areas of irrational thinking, such as a tendency to catastrophize difficulties or assume the world is out to get you, and adopt a more balanced and realistic thinking pattern. For instance, if you feel overwhelmed by a challenge, remind yourself that what happened to you isn’t an indicator of how your future will go, and that you’re not helpless. You may not be able to change a highly stressful event, but you can change how you interpret and respond to it. Accept change. Accept that change is a part of life. Certain goals or ideals may no longer be attainable as a result of adverse situations in your life. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter. Maintain a hopeful outlook. It’s hard to be positive when life isn’t going your way. An optimistic outlook empowers you to expect that good things will happen to you. Try visualizing what you want, rather than worrying about what you fear. Along the way, note any subtle ways in which you start to feel better as you deal with difficult situations. Learn from your past. By looking back at who or what was helpful in previous times of distress, you may discover how you can respond effectively to new difficult situations. Remind yourself of where you’ve been able to find strength and ask yourself what you’ve learned from those experiences. Seeking help Getting help when you need it is crucial in building your resilience. For many people, using their own resources and the kinds of strategies listed above may be enough for building their resilience. But at times, an individual might get stuck or have difficulty making progress on the road to resilience. A licensed mental health professional such as a psychologist can assist people in developing an appropriate strategy for moving forward. It is important to get professional help if you feel like you are unable to function as well as you would like or perform basic activities of daily living as a result of a traumatic or other stressful life experience. Keep in mind that different people tend to be comfortable with different styles of interaction. To get the most out of your therapeutic relationship, you should feel at ease with a mental health professional or in a support group. The important thing is to remember
you’re not alone on the journey. While you may not be
able to control all of your circumstances, you can grow by
focusing on the aspects of life’s challenges you can
manage with the support of loved ones and trusted
professionals. Does
Gender Affect Resilience? In terms of survival and longevity, women historically thrive in greater numbers than men during times of crisis such as famines and epidemics. Even when overall life expectancy rose, researchers found women outlived men between six months and four years, according to an article published in January 2018 in Proceedings of the National Academy of Sciences. (19) On the other hand, studies have found that women are approximately twice as likely as men to develop PTSD after a traumatic event. The reason for the gender difference is unclear, but it may have something to do with coping style for dealing with trauma. (20) Resilience in Women Resilience benefits both men and women when facing challenges and adversity. However, women also draw on resilience to overcome obstacles more often placed in their way, such as job discrimination, sexual harassment, and domestic violence. One study found that when confronted with gender bias in the workplace, women relied on adopting male characteristics, mentoring, and intrinsic motivational factors to work through obstacles. (21) Resilience in Men Resilience can protect both men and women from mental health conditions, such as depression and anxiety. (22) Research has found that men who lack resilience are exponentially more vulnerable to becoming severely depressed after the loss of a spouse. The study, published in September 2018 in the journal The Gerontologist, also showed that men with high resilience showed no additional depressive symptoms following a loss, and their overall well-being almost mirrored that of their married counterparts. (23) Another study, published in 2014 in
the journal Progress in Community Health Parterships,
focused on perceived sources of stress and resilience,
specifically among African American men, and found that most
men found support for resiliency through family and
religion. (24) Putting
resilience and resilience surveys under the
microscope Sounds fantastic. But what exactly does resilience mean? Resilience generally describes the bounce-back ability of individuals who return to the similar shape, form and condition after misfortune, harm or injury. But how does resilience work? Is resilience something one can ingest, like Popeye’s spinach, to become stronger whenever out sized by stress? Can it be put on like Wonder Woman’s bracelets to protect against threat? Can it be given, taken or shared? Is resilience an internal trait, an external circumstance or some mysterious blend of both? “There’s always the debate about what’s called state versus trait: Is (resilience) something enduring in a person or is it going to come and go from week to week? The answer is somewhere in the middle,” says Dr. Jonathan R.T. Davidson, emeritus professor of psychiatry at Duke University Medical Center and co-creator, with Dr. Kathryn M. Connor, of the Connor-Davidson Resilience Scale (CD-RISC). “What we often considered to be enduring characteristics in people can, in fact, change over the course of several weeks in response to some appropriate prompting. So resilience is a bit of both.” While working together at the Anxiety and Traumatic Stress Program at Duke University in 2003, Connor and Davidson noticed that some people with post-traumatic stress were “able to bounce back better”, he says, which is how they got interested in resilience. “It was not a concept that people really spoke about in medical practice, that’s for sure,” he says. Up to that point, research on resilience was done mostly by psychologists focused on child development. It wasn’t looked at much in adults, and there wasn’t what they thought was a good scale to measure it, either. So, they “borrowed various concepts” from the available research, “and incorporated them” into their own to create the CD-RISC scale in 2003. Since resilience is a word without a universal meaning, I ask Davidson to explain what he means when he uses the word. “Resilience is the ability to bounce back, pick yourself up from the ground if you’ve been dealt some blows, to be able to cope well or effectively with adverse conditions,” he explains. “It certainly includes various properties like being optimistic, having confidence in yourself, or belief in yourself to overcome things, to have the skills you need, social support, ability to find some meaning or purpose in life. Probably one of the most important or critical things of all is something called hardiness,” which is thought to be a mix of commitment, control and challenge. Resilience: One word, many scales There is no “gold standard for measurement tools,” was the first conclusion in “A methodological review of resilience measurement scales” published in Health Quality Life Outcomes in 2011. Notable challenges mentioned were “…. the complexity of defining the construct of resilience” and the absence of “an operational definition of resilience.” This remains true in 2017. Not only is the word itself, complex, but the tools vary, too. Some tools are long. Some are short. Some are self-administered and some are not. Some are used with infants and toddlers while others are used with teens and adults. There are resilience surveys, scales and checklists, words often used as though they are “interchangebale,” explains Alleyne, though “they are not identical.” From a lay person’s perspective, resilience measures appear to fall into one of three categories: research-based, research-informed, and just for fun. Research-Based These are tools that are evidence-based, validated by science and have specific applications for screening people for resilience. They might have clinical use or be used for research or in educational or professional settings, as well as more broadly, with basic training recruits, athletes focused on peak performance and those in high stress jobs such as first responders. The Deveraux child assessments and the Connor-Davidson scale are examples of this type. The Connor-Davidson scale has been paired with a 14-question childhood adversity survey to assess the parents of four-month-old babies in a pediatric clinic in Portland, OR. The clinic’s pediatricians find that parents who have low ACE scores and high resilience scores have fewer challenges in parenting than parents with high ACE scores and low resilience scores, and parents who have high ACE scores and high resilience scores fall somewhere in between. A primary care clinic in Pueblo, CO, pairs the Connor-Davidson scale with a 10-question childhood adversity survey to assess the children and their parents. “DCRC’s child assessments are all standardized, strength-based, reliable, valid, normed tools that provide standardized scores that can be used to measure outcomes and/or to drive program design and strategies related to protective factors and social and emotional wellbeing,” says Alleyne. Rosanblaum often uses two of the Devereux scales “as screening tools and to assess change over time” in her work which “focuses on the ‘self-regulation’ part of resilience – successfully managing your thoughts, feelings, and behaviors to reach positive goals.” Research-Informed These are educational, supportive and practical. These are tools and materials used to educate, provide support or guidance and direction. They might have some scientific basis and rely on research, but they are not generally used for assessment or screening. They may share information in checklist fashion or be general surveys that might help identify resilience factors in childhood or current personal strengths, and be used in specific groups such as students or parents. The Deveraux survey for adults falls in this category as does the resilience questionnaire on Got Your ACE Score? on ACEsTooHigh.com. Just for Fun These are informal and perhaps the most popular. They can be found easily online or in magazines. Some may be somewhat based in research or science, such as the resilience quiz online at PBS Kids. Others have a narrow focus only on resilience, such as how fast someone recovers from minor disappointments and huge losses (see “What’s Your Emotional Style?). More detailed descriptions of these and other resilience tools can be found in the ACESConnection.com Resource Center. What’s so useful about resilience if you’ve got ACEs? Or a better question is: Since resilience is about “bouncing back” to original shape and form, what might it mean for those without any concept of what to bounce back to, those who have experienced adversity as environment more than event? For many, toxic stress in childhood was chronic and cumulative. The CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study) clearly showed that childhood trauma adversity is quite common, and is linked to the adult onset of chronic disease, mental illness, violence and being a victim of violence. The research, led by Dr. Vincent Felitti (Kaiser) and Dr. Robert Anda (CDC) measured 10 types of childhood adversity that occurred before the age of 18. They are physical (1), verbal (2) and sexual abuse (3); physical (4) and emotional (5) neglect; a family member who has been incarcerated (6), is abusing alcohol or drugs (7), or has a mental illness (8), witnessing a mother being abused (9); and losing a parent to divorce or separation (10). The lowest possible score is 0 and the highest 10. Many other types of childhood adversity exist as well, such as racism, bullying, violence outside the home, being homeless, accidents, natural disasters and major illness or other adversities, but this study focused just on the 10 above. The researchers found that the higher a person’s ACE score, the greater the risk of chronic disease and mental illness. They also found that ACEs contribute to most of our major chronic health, mental health, economic health and social health issues. Of the 17,000 mostly white, college-educated people with jobs and great health care who participated in the study, 64 percent had an ACE score of 1 or more; 40 percent had 2 or more and 12 percent had an ACE score of 4 or more (i.e., four out of the 10 different types of adversity). Compared with someone who has an ACE score of zero, a person with an ACE score of 4 or more is twice as likely to have heart disease and cancer, seven times more likely to be addicted to alcohol and 12 times more likely to attempt suicide. But what and how do children and adults fair when ACEs are coupled with resilience factors and how is that measured, determined or quantified? “A child might have temperamental resilience – just an easygoing optimism, determination, etc. – that is quite protective against adversity,” says Dr. Katie Rosanbalm, a research scholar at the Center for Child and Family Policy at Duke University. “I think it is more common that protective factors such as nurturing relationships with supportive adults will build a child’s resilience – in which case, if you are a statistician, you would consider resilience as the mediator that leads to positive outcomes.”resilience-1 I ask: Is resilience is a protective factor in and of itself, or does the presence of protective factors build a child’s resilience? “Both,” she answers. “I think resilience and other protective factors are mutually supportive and create a positive cycle that builds over time.” “ACEs are a set of specific risk factors. In the broader view, risk factors are those challenges all children and adults face in life. Without protective factors to buffer the negative effects of risk, there is an increased likelihood of a negative life outcome,” says Alleyne. There are those of us who recoil from the word resilience. It can be a sensitive subject, both painful and polarizing. Many see resilience as a possible antidote to the avalanche of adversity in the world. However, many trauma survivors, with experiences that are often minimized, marginalized or medicalized, are often frustrated by what seems like excessive funding for or fascination with resilience. It can seem as though resilience and protective factors can get overemphasized while the prevention and treatment of ACEs ends up sidelined – as though human suffering might be optional if it’s served up with enough resilience. For many, however, resilience is a word that feels hopeful, healthful and healing. Researchers such as Rosanbalm remain enthusiastic about resilience research. She views resilience as resilience-14“a crucial strength that we can build on!” in children or adults. Rosanbalm says. “Or, alternately, that we can seek to enhance if we know some aspect of resilience is lacking. In measuring resilience, we seek to learn where a certain person is at the moment, and how we might best help that person to develop new skills and supports so that they can become MORE resilient. The assessment is simply a tool that teaches us about areas for growth and how best to promote change.” Others see resilience tools as simple ways to measure the effectiveness of particular approaches such as yoga, meditation, medication, therapy or stress management. Plus, as Rosanbalm explains: “Resilience is a multi-factor construct – so measuring resilience could be about measuring self-regulation, or motivation, or attitudes, etc., etc.” For her, the key is in being specific: “It is important to think about what EXACTLY you want to be measuring when you pick a tool.” When it comes to people and how tools are used, context matters. However, it is impossible to tell how culturally-sensitive or trauma-informed any specific tool is and how much this matters to those who create and use resilience tools. Alleyne, who works with families, reminds me that “an effective assessment not only offers a means of measuring desired behaviors, but also can serve to foster effective communication among all adults who know and care for the child.” Resilience as a conversation, not just a score Dr. Mark Rains, a clinical psychologist with three decades plus experience, has a private practice in Farmington, Maine, where he also participates in the Maine Resilience Building Network (MRBN). MRBN was founded in 2012 with the mission of increasing awareness about ACEs and resilience. He consults about traumatic stress as part of the leadership team of the Pediatric Integrated Care Collaborative (PICC), PICC’s work involves many ways of “protecting children from exposure to traumatic stress, supporting and soothing them so that their experience of stress is not so traumatic, and promoting family strengths and child resilience,” he writes. PICC is funded by the Substance Abuse Mental Health Service Administration and based at John Hopkins University within the National Child Traumatic Stress Network. The PICC framework seems to go beyond traditional efforts to prevent abuse, neglect and dysfunction – great, but not always possible – and includes a robust, cross-sector response to traumatic stress, when it occurs. An integrated team of family, community members and primary care and mental health providers work with families. “Part of what we look at is a trauma history, but also family and community protective factors and children’s resilience expectations and how those overlap,” says Rains. PICC uses “a wide variety of tools for identifying stress exposure,” which includes ACE questionnaires developed by the Center for Youth Wellness, called the ACE-Q, the Safe Environments for Every Kid (SEEK) model and the Survey of Well-Being of Young Children (SWYC). “There are at least four ways to look at a stress history: surveillance, questions, screening, and in in-depth assessment of experiences and effects,” notes Rains. Surveillance is basically “being informed about the possibility that problems in health and behavior may relate back to unresolved stress,” and the way a provider remains tuned in, he explains. “It’s like the lifeguard watching the whole beach, prepared to take a closer look if someone might be having trouble.” Questions are “helpful in opening conversations about stresses and coping,” he says. Specifically, the three structured ones created by a team in PICC’s Learning Collaborative and used at the University of New Mexico’s Children’s Health Center, which are as follows:
Screening provides “a more formal way to gather information” he says. He uses the ACE questionnaire, “which is gaining in popularity as a screening tool” although it was not originally designed for this purpose. While it, and other tools are “enlightening about trauma exposure,” he says, they “fail to take into account how a person experienced adversity and whether this led to trauma effects.” Getting the ACE score alone allows someone to share a number, and the categories of adversity experienced, without needing to say which ones. This, he says, can “begin a conversation about health and coping,” without the “stigma of documenting trauma” the “need for a mandated report” or even “overwhelming the training of service providers prepared to discuss stress and health, but not specific traumas or PTSD.” In-Depth Assessment of Experiences and Effects Once Rains knows a person’s ACE score, he asks follow-up questions that allow him to understand how ACEs have been experienced by a person. He does not assume that all ACEs are a problem for people in the present. In fact, he proposes “summing the number of adversity categories that still bother a person and reflecting on how protective factors, life changes, and resilience contribute.” His goal is move the conversation from “impairment to strengths,” because someone with an ACE score of 6 might only be bothered by three of the ACEs. The difference between these numbers “is kind of a measure of resilience” and one he believes worthy of exploration. In practice, he is likely to engage in a “resilience conversation” instead of obtaining a resilience score. This might surprise people, because in 2006 Rains worked with pediatricians, psychologists, and health advocates from Southern Kennebec Healthy Start in Augusta, Maine, to develop a popular research-informed resilience questionnaire. They created it to provide some balance for the ACE questionnaire, which focuses only on trauma. Today, he has misgivings about his involvement, “apologizing for potential misrepresentation of a list of resilience conversation items he had helped compile that may have been construed as a Resilience Questionnaire, as if it yielded a ‘Resilience Score,” as “there is no validity data to support that to offset an ACE Score.” He worries that a score alone (whether for ACEs or resilience) may mislead people as much or more than it is helpful. He questions whether knowing one’s ACE score alone is helpful for individuals because “we are making it sound like it means more than it really is. Like a person with an ACE score of 6 is different than a person with an ACE score with a 4,” he says. There’s a difference between what’s statistically significant, “which we write papers about” and what’s clinically significant, “which is more of what it means for the actual person.”resilience-13 This is important, he says: “If I come out of trauma feeling unsafe, feeling shamed or unloved, expect to be helpless or not capable or can’t make sense out of things… then I probably stay stressed.” He emphasized that “multiple ACEs may contribute to such expectations, especially if they include abuse or neglect from caregivers. Chronic stress and unhealthy attempts to manage it may actually be what lead to the negative outcomes, rather than simply the number of ACEs.” Rains said the the term “toxic stress” has becoming popular” but that it would be more accurate to say, “chronically unsoothed stress” instead. Rains cites the work of Drs. Jack P. Shonkoff and Andrew S. Garner, two pediatricians who defined toxic stress as “the third and most dangerous form of stress response,” in an article entitled, The Lifelong Effects of Early Childhood Adversity and Toxic Stress, published in the journal Pediatrics in 2012. “Toxic stress,” they wrote, “can result from strong, frequent, or prolonged activation of the body’s stress response systems in the absence of the buffering protection of a supportive, adult relationship.” “Take two children who experience the same stress,” Rains explains. “One of them might have a parent who’s able to help their response system get back to normal and the other might remain stressed without the support system to help them feel safe again. That chronic stress may lead to toxic effects.” He explains how toxic effects can damage children: “A trauma stress response gets activated. Typically, we deal with the trauma and it passes. Stress goes back to normal. Cortisol goes up and down. We’re OK. Part of resilience for a child is being in a relationship that can protect them, preventing stress from happening or soothing it. If that doesn’t happen and the stress response remains active… if stress doesn’t get soothed, there can be toxic effects, in brain, endocrine, immune, emotional, and behavioral systems,” he writes. Being overwhelmed by stress, he explains, and not being soothed, is what robs people of one or more of these four expectations — that one is safe, capable, lovable and that life makes sense. Finding a way to get back these expectations is what “getting your resilience back” means in a practical sense.resilience-9 Rains does not rely on scores alone (ACE or resilience), though he acknowledges screenings help identify children and families who might need support and possible intervention. Instead, he favors an approach that explores how safe, lovable, capable and meaningful a person feels. The specific resilience tools being considered by PICC “for application within the integrated care for early childhood stress program,” he says, are as follows:
Putting resilience into practice Dr. Emmy Werner had a research project in Hawaii where she studied nearly 700 people over 40 years – all the babies born on the island of Kauai in 1955 — from infancy through adolescence and adulthood. “They could look at what kind of characteristics in childhood made a difference in whether people had problems later on,” says Rains. Werner found that one-third of the high-risk children grew into adults who were caring and successful. One of the main reasons, says Rains, “is that having a secure, supportive relationship in early childhood is one of best predictors of whether you’d be resilient later in childhood and into adulthood. If you had at least one relationship where people were able to do that soothing, protecting…or help you build strength, if you had at least that one relationship at least that could protect you from many other stress exposures.” He adds: “It wasn’t how many of those relationships you had, it’s not the kind of thing that added up, as much as if you had just one.” That one “could be protective. Two would be better. But it’s not like six relationships is six times better than one. If you had one or two, then that was good; if you didn’t have any then that could be a risk. So that’s where having a secure relationship early on helped you be resilient later.” “It basically takes one good relationship” he says, that “teaches you from experience that you are safe-lovable-capable-meaningful.” What was also interesting about the Kauai study was that most of the teens who were troubled during adolescence had recovered to become successful in their 30s and 40s, due to the availability of adult high school, trade school and community colleges, joining the military or becoming involved in a religion, or marrying a stable person or having a stable job. Nevertheless, even the people who Werner described as “resilient” developed a high rate of stress-related health problems by their 30s, indicating that although a secure, supportive relationship helped them achieve their goals, their childhood adversity may still have left its mark on their health. Rains notes that the “findings about protective factors in early childhood and resilience” come not only from the Kauai Longitudinal Study,” but also from the Minnesota Longitudinal Study of Risk and Adaptation. Both emphasize “the importance of an early secure attachment relationship, as well as ongoing support and opportunities to repair early attachment difficulties.” In other words, the impacts of trauma, toxic stress and resilience are all relevant to adults. To build resilience in adults, Rosanbalm believes two other “R” words are crucial to children: relationships and regulation. Rosanbalm works on “building trauma-informed schools – positive climates where WHOLE kids are nurtured, not just drilled with times tables” and works with caregivers as well “to teach people (kids in my case) the coping skills and social-emotional skills that they need to really experience their feelings, yet not be overwhelmed and controlled by them.” She says if caregivers learn “how to build the warm, nurturing relationships AND how to create the structure and skill-building to support child regulation, I think these two together go a long way to building resilient kids with positive outcomes.” In other words, resilience is relational but need come only from relatives or family members, though it might, but also within the wider community in which a child lives. Alleyne agrees. In fact, she insists
“Protective factors and resilience can be nurtured in
all children no matter their risk or ACEs” and that
“no child or adult is without hope for
healing”. What
Is Resilience? Your Guide to Facing Life's Challenges,
Adversities, and Crises What is resilience, why is it so important, and how do you know if you’re resilient enough? Resilience is typically defined as the capacity to recover from difficult life events. “It’s your ability to withstand adversity and bounce back and grow despite life’s downturns,” says Amit Sood, MD, the executive director of the Global Center for Resiliency and Well-Being and creator of Mayo Clinic Resilient Mind in Rochester, Minnesota. Resilience is not a trampoline, where you’re down one moment and up the next. It’s more like climbing a mountain without a trail map. It takes time, strength, and help from people around you, and you’ll likely experience setbacks along the way. But eventually you reach the top and look back at how far you’ve come. Common Questions & Answers What does it mean to be resilient? Resilience is the ability to withstand adversity and bounce back from difficult life events. Being resilient does not mean that people don’t experience stress, emotional upheaval, and suffering. Some people equate resilience with mental toughness, but demonstrating resilience includes working through emotional pain and suffering. Why is resilience important? Resilience is important because it gives people the strength needed to process and overcome hardship. Those lacking resilience get easily overwhelmed, and may turn to unhealthy coping mechanisms. Resilient people tap into their strengths and support systems to overcome challenges and work through problems. How do I know if I’m resilient? A survey conducted by Everyday Health, in partnership with The Ohio State University, found that 83 percent of Americans believe they have high levels and emotional and mental resilience. In reality, only 57 percent scored as resilient. Take the Everyday Health Assessment to find out your resilience score, and learn what skills you should develop to become more resilient. What are examples of resilience? There is emotional resilience, in which a person can tap into realistic optimism, even when dealing with a crisis. Physical resilience refers to the body’s ability to adapt to challenges and recover quickly. Community resilience refers to the ability of groups of people to respond to and recover from adverse situations, such as natural disasters, acts of violence, or economic hardship. What are the 7 Cs of resilience? The 7 Cs resilience model was developed by pediatrician Ken Ginsberg, MD, to help children and adolescents build resilience. Learning competence, confidence, connection, character, contribution, coping, and control is how Ginsberg says we can build inner strength and utilize outside resources — regardless of age. What Is Resilience Theory? People experience all kinds of adversity in life. There are personal experiences, such as illness, loss of a loved one, abuse, bullying, job loss, and financial instability. There is the shared reality of tragic events in the news, such as terrorist attacks, mass shootings, and natural disasters. People have to learn to cope with and work through very challenging life experiences. Resilience theory refers to the ideas surrounding how people are affected by and adapt to things like adversity, change, loss, and risk. Being resilient does not mean that people don’t experience stress, emotional upheaval, and suffering. Some people equate resilience with mental toughness, but demonstrating resilience includes working through emotional pain and suffering. Resilience isn’t a fixed trait. Flexibility, adaptability, and perseverance can help people tap into their resilience by changing certain thoughts and behaviors. Research shows that students who believe that both intellectual abilities and social attributes can be developed show a lower stress response to adversity and improved performance. (1) Dr. Sood, who is a member of the Everyday Health Wellness Advisory Board, believes that resilience can be defined in terms of five principles:
Top Factors of Resilience Developing resilience is both complex and personal. It involves a combination of inner strengths and outer resources, and there isn’t a universal formula for becoming more resilient. All people are different: While one person might develop symptoms of depression or anxiety following a traumatic event, another person might not report any symptoms at all. A combination of factors contributes to building resilience, and there isn’t a simple to-do list to work through adversity. In one longitudinal study, protective factors for adolescents at risk for depression, such as family cohesion, positive self-appraisals, and good interpersonal relations, were associated with resilient outcomes in young adulthood. (2) While individuals process trauma and adversity in different ways, there are certain protective factors that help build resilience by improving coping skills and adaptability. These factors include:
Research on resilience theory shows that it is imperative to manage an individual’s immediate environment and promote protective factors while addressing demands and stressors that the individual faces. (4) In other words, resilience isn’t something people tap into only during overwhelming moments of adversity. It builds as people encounter all kinds of stressors on a daily basis, and protective factors can be nurtured. Why Is Resilience Important? Resilience is what gives people the emotional strength to cope with trauma, adversity, and hardship. Resilient people utilize their resources, strengths, and skills to overcome challenges and work through setbacks. People who lack resilience are more likely to feel overwhelmed or helpless, and rely on unhealthy coping strategies (such as avoidance, isolation, and self-medication). One study showed that patients who had attempted suicide had significantly lower resilience scale scores than patients who had never attempted suicide. (5) Resilient people do experience stress, setbacks, and difficult emotions, but they tap into their strengths and seek help from support systems to overcome challenges and work through problems. Resilience empowers them to accept and adapt to a situation and move forward. Resilience is “the core strength you use to lift the load of life,” says Sood. What Are the 7 Cs of Resilience? Pediatrician Ken Ginsburg, MD, who specializes in adolescent medicine at the Children’s Hospital of Philadelphia, developed the 7 Cs model of resilience to help kids and teens build the skills to be happier and more resilient. The 7 Cs model is centered around two key points:
The American Academy of Pediatrics summarizes the 7 Cs as follows:
The 7 Cs of resilience illustrate the interplay between personal strengths and outside resources, regardless of age. Types of Resilience: Psychological, Emotional, Physical, and Community The word resilience is often used on its own to represent overall adaptability and coping, but it can be broken down into categories or types:
What Is Psychological Resilience? Psychological resilience refers to the ability to mentally withstand or adapt to uncertainty, challenges, and adversity. It is sometimes referred to as “mental fortitude.” People who exhibit psychological resilience develop coping strategies and capabilities that enable them to remain calm and focused during a crisis and move on without long-term negative consequences. What Is Emotional Resilience? There are varying degrees of how well a person copes emotionally with stress and adversity. Some people are, by nature, more or less sensitive to change. How a person responds to a situation can trigger a flood of emotions. Emotionally resilient people understand what they’re feeling and why. They tap into realistic optimism, even when dealing with a crisis, and are proactive in using both internal and external resources. As a result, they are able to manage stressors as well as their emotions in a healthy, positive way. What Is Physical Resilience? Physical resilience refers to the body’s ability to adapt to challenges, maintain stamina and strength, and recover quickly and efficiently. It’s a person’s ability to function and recover when faced with illness, accidents, or other physical demands. Research published in April 2016 in The Journal of Gerontology showed that physical resilience plays an important role in healthy aging, as people encounter medical issues and physical stressors. (7) Healthy lifestyle choices, building connections, making time to rest and recover, deep breathing, and engaging in enjoyable activities all play a role in building physical resilience. What Is Community Resilience? Community resilience refers to the ability of groups of people to respond to and recover from adverse situations, such as natural disasters, acts of violence, economic hardship, and other challenges to their community. Real-life examples of community resilience include New York City following the 9/11 terrorist attacks; Newtown, Connecticut, after the Sandy Hook Elementary School shooting; New Orleans following Hurricane Katrina; and the communities of Gilroy, California, El Paso, Texas, and Dayton, Ohio, in the wake of recent mass shootings. Research and Statistics on Resilience Research into what promotes resiliency supports the idea that certain protective resources, rather than the absence of risk factors, play a significant role in a person’s capacity to confront and work through stressors. (8) Things like social support, adaptive coping skills, and the ability to tap into one’s inner strengths can help develop and strengthen resiliency in an individual. When it comes to the idea of “natural resilience,” or a person’s innate ability to recover from adversity, the research is mixed. Some studies suggest human resilience in the face of adversity is fairly common. To support this, one study reported that even though 50 to 60 percent of the U.S. population is exposed to traumatic events, only 5 to 10 percent of those people develop post-traumatic stress disorder (PTSD). (9) Nevertheless, other research highlights the difficulty in studying resilience. One particular study, published in March 2016 in the journal Perspectives on Psychological Science, examined spousal loss, divorce, and unemployment and found that the statistical model used to interpret the resilience scores greatly influenced the results. (10) The authors concluded that prior research may have overestimated how common resilience is, and suggested that resilience may be more difficult to quantify and study than previously thought. Resilience Training The good news is that resilience can be learned. For example, people can build up social support networks or learn to reframe negative thoughts. Learning to be resilient doesn’t mean figuring out how to “grin and bear it” or to simply “get over it.” It’s not about learning to avoid obstacles or resisting change. Building resilience is a process by which people utilize flexibility to reframe thought patterns and learn to tap into a strengths-based approach to working through obstacles. How to Build and Cultivate Resilience It’s helpful to think of resilience as a process. The following are steps that can help build resilience over time: Develop self-awareness. Understanding how you typically respond to stress and adversity is the first step toward learning more adaptive strategies. Self-awareness also includes understanding your strengths and knowing your weaknesses. How Resilient Are You? Resilience is not a permanent state. A person may feel equipped to manage one stressor and overwhelmed by another. Remember the factors that build resilience, and try to apply them when dealing with adversity. In general, resilient people have many of the following characteristics:
Resilience and Health Conditions Studies have shown that characteristics of resilience, particularly social connections and a strong sense of self-worth, help people confronting chronic illness. (11) A review of research on resilience and chronic disease published in April 2015 in the journal Cogent Psychology suggested that a patient’s resilience can influence both the progression and outcome of illnesses. (12) Mental Health and Resilience Resilience is a protective factor against psychological distress in adverse situations involving loss or trauma. It can help in the management of stress levels and depressive symptoms. Psychological resilience refers to the mental fortitude to handle challenges and adversity. Rheumatoid Arthritis and Resilience Research found that behavioral and emotional strategies to cultivate resilience can benefit patients with rheumatoid arthritis (RA) and other chronic diseases. One study concluded that optimism and perceived social support help improve the quality of life for RA patients. (13) Immunological Disorders and Resilience Research supports the idea that physical resilience can reduce the adverse effect that stressors have on the immune system. Studies have shown that low resilience is associated with worsening of disease, whereas high resilience is associated with better quality of life. (12) Brain Injuries and Resilience One study, published in July 2015 in the Journal of Neurotrauma, showed that patients with traumatic brain injuries who tested moderate-high on a resilience scale reported significantly fewer post-injury symptoms and better quality of life than those with low resilience. (14) Type 2 Diabetes and Resilience According to the Mayo Clinic, high levels of resilience in diabetes patients are associated with lower A1C levels, indicating better glycemic control. (15) Cancer and Resilience Research published in April 2019 in the journal Frontiers in Psychiatry linked resilience, notably personal strengths and social factors, to improved psychological and treatment-related outcomes for cancer patients. (16) Digestive Conditions and Resilience People suffering from anxiety and depression frequently report gastrointestinal distress as a primary symptom. Building resilience can reduce the stress and anxiety associated with some GI symptoms. Research published in January 2018 in the journal Neurogastroenterology and Motility showed a connection between low resilience and worsened irritable bowel syndrome (IBS) symptoms. (17) Skin Conditions and Resilience Dermatologic disorders are often accompanied by anxiety and stress. Stress, in turn, can trigger flare-ups of skin-related conditions, such as psoriasis and eczema. Studies suggest that patients with conditions like psoriasis show signs of less resilience, and early intervention to build resilience can improve symptoms and management of these conditions. Endometriosis and Resilience Studies have linked endometriosis and chronic, potentially debilitating pain to depressive mood, anxiety, and reduced resilience. Resilience can be an important factor in reducing the effects on physical, mental, and social well-being. Resilience in Children Kids confront any number of challenges as they grow — from starting school and making new friends to adverse, traumatic experiences, such as bullying and abuse. “Building resilience — the ability to adapt well to adversity, trauma, tragedy, threats, or even significant sources of stress — can help our children manage stress and feelings of anxiety and uncertainty,” according to the American Psychological Association (APA). (18) The 7 Cs model specifically addresses resilience building in kids and teens. It lists competence, confidence, connection, character, contribution, coping, and control as essential skills for young people to handle situations effectively. Parents can help children develop resilience through positive behaviors and thoughts. The APA lists 10 tips for building resilience in young people: Foster social connections
There is no universal formula for building resilience in young people. If a child seems overwhelmed or troubled at school and at home, parents might consider talking to someone who can help, such as a counselor, psychologist, or other mental health professional. Does Gender Affect Resilience? Studies on resilience and gender suggest that men and women may respond differently to adversity and trauma. But the results have been conflicting. In terms of survival and longevity, women historically thrive in greater numbers than men during times of crisis such as famines and epidemics. Even when overall life expectancy rose, researchers found women outlived men between six months and four years, according to an article published in January 2018 in Proceedings of the National Academy of Sciences. (19) On the other hand, studies have found that women are approximately twice as likely as men to develop PTSD after a traumatic event. The reason for the gender difference is unclear, but it may have something to do with coping style for dealing with trauma. (20) Resilience in Women Resilience benefits both men and women when facing challenges and adversity. However, women also draw on resilience to overcome obstacles more often placed in their way, such as job discrimination, sexual harassment, and domestic violence. One study found that when confronted with gender bias in the workplace, women relied on adopting male characteristics, mentoring, and intrinsic motivational factors to work through obstacles. (21) Resilience in Men Resilience can protect both men and women from mental health conditions, such as depression and anxiety. (22) Research has found that men who lack resilience are exponentially more vulnerable to becoming severely depressed after the loss of a spouse. The study, published in September 2018 in the journal The Gerontologist, also showed that men with high resilience showed no additional depressive symptoms following a loss, and their overall well-being almost mirrored that of their married counterparts. (23) Another study, published in 2014 in the journal Progress in Community Health Parterships, focused on perceived sources of stress and resilience, specifically among African American men, and found that most men found support for resiliency through family and religion. (24) Resilience in Caregiving The burden of caring for someone, such as an older adult or a chronically ill loved one, can be a tremendous source of stress and affect a caregiver’s well-being. Research has shown that social support is a key moderating factor for resilience among caregivers. That support can be provided by family members and friends, as well as physicians and social workers. One study, published in January 2018 in the journal BMC Psychiatry, stressed that healthcare professionals should help identify supportive family members and friends to help alleviate caregiver burden. (25) Quotes and Inspiration to Make You Feel Resilient There are many ways to encourage resilience in people. Something as simple as an inspiring quote can be empowering. There are also surprising forms of expression, like tattoos, that can tell stories of resilience and serve as motivational examples. Inspirational Quotes of Resilience Below are several quotes on different aspects of resilience, from finding inner strength to surviving life’s challenges. "She stood in the storm and when the wind did not blow her way, she adjusted her sails." — Elizabeth Edwards, author "The greatest glory in living lies not in never falling, but in rising every time we fall." — Nelson Mandela "Resilience is knowing that you are the only one that has the power and the responsibility to pick yourself up."— Mary Holloway, resilience coach “The human capacity for burden is like bamboo — far more flexible than you'd ever believe at first glance.” — Jodi Picoult, My Sister’s Keeper “Perhaps what matters when all is said and done is not who puts us down but who picks us up.” — Kate DiCamillo, Louisiana’s Way Home “Grief and resilience live together.” — Michelle Obama, Becoming “On the other side of a storm is the strength that comes from having navigated through it. Raise your sail and begin.” — Gregory S. Williams, author “When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has been opened for us.” — Sheryl Sandberg, Option B: Facing Adversity, Building Resilience, and Finding Joy “Since our problems have been our
own creation “Adversity has the remarkable ability of introducing the real you to yourself.” — M.B. Dallocchio, The Desert Warrior “Even the tiniest of flowers can have the toughest roots.” — Shannon M Mullen, See What Flowers Tattoos to Inspire Resilience Once considered taboo or a sign of defiance, tattoos have become practically mainstream. Tattoos can mean different things and serve many purposes — from being a form of artistic self-expression to commemorating an important event or recognizing someone special. They can also symbolize a person’s resilience in the face of adversity. From words and phrases to symbols and poetry, tattoos remind people of their strength and how they have overcome challenges such as an illness or loss. Getting a tattoo is a decision that should be carefully considered, but it can be a source of inspiration to yourself and others. Resilience in Books, Movies, and TV Shows Literature and pop culture provide reminders that resilience is common to the human condition. Here are some of the top reads, films, and shows about ways to build inner strength and stories of people who drew on their own resilience. 5 of the Top Books on Resilience
5 of the Top Movies, Documentaries, and TV Shows on Resilience
Examples of Resilience Stories of public figures, celebrities, and other personalities who have overcome challenges in life can help others feel less alone and even be empowering. Celebrities Who Are Resilient
Stories of Resilience Every day, people from all walks of life face health and personal challenges. Their stories of resilience offer hope and inspiration to others facing adversity.
Resilience in Fitness and Weight Loss Adopting a healthy lifestyle that includes balanced meals and regular exercise requires resilience. It can be difficult to change habits, particularly when it comes to curbing negative eating and sleeping habits. Persistence, realistic optimism, and support systems can help people develop healthier lifestyles. Exercising with a friend, for example, makes the process more fun and less isolating. Getting the whole family involved in healthy meal planning makes it less stressful. Changing habits involves a healthy dose of self-awareness. People have to be able to look inward and find where they’re making mistakes before they can create new habits. Putting supports in place to keep you on track will help you meet your goals and create better habits. Resources We Love Websites About Resilience For more information on the importance of resilience, what you can do to build up resilience, and how to practice it in your life, visit the following resources: The Human Rights Resilience Project This website brings together research, resources, and tools to improve resilience and well-being within the human rights community. American Psychological Association — The Road to Resilience Compiled by the American Psychological Association, this resource helps people learn how to cope with difficult life situations, including trauma. Mental Health Services It can be difficult to know how and when to get help with feelings of anxiety, depression, and other mental health conditions. Reaching out for help is a good first step toward building resilience and improving your overall well-being. Suicide Prevention Lifeline If you are thinking about suicide or are worried about a loved one, the Suicide Prevention Lifeline is open 24/7 in the United States to assist you by connecting you with a trained crisis worker. Crisis Text Line Available 24/7 in the United States, Canada,(Text "SOS" on741741) and the United Kingdom, the Crisis Text Line connects every texter with a crisis counselor for confidential help on the spot. Good Therapy It can be hard to know where to start when looking for a therapist. Good Therapy helps you find support right in your ZIP code. Educational Resources Young people need help learning to develop resilience in a stressful world. It isn’t as easy as telling them to try again. They need specific resources. Edutopia: Resources on Developing Grit, Resilience, and Growth Mindset This is a curated list of resources to help parents and educators teach and support grit, resilience, and growth mindset. LGBTQ Support and Resources Related to Bullying Marginalized youth have a higher risk of bullying, violence, and suicide. There are resources out there to help all youth know that they are not alone. Born This Way Foundation Born This Way supports the wellness of young people using evidence-based programs that are kind, compassionate, accepting, and inclusive. The Trevor Project The Trevor Project provides support and resources for LGBTQ youth, including a 24/7 crisis line with trained counselors on call. StopBullying.gov All kids involved in bullying (victims, bullies, witnesses) are affected it by it. StopBullying.gov compiled resources to help parents, schools, and communities decrease bullying. 2019
- A Year of Resilience When I considered what it meant to be resilient, I thought about my fore-parents and ancestors who literally came up from the dirt and, amidst the struggles of poverty and lack of educational opportunities, somehow eked a living out of the land. Not only did they become expert farmers, but they built strong, Christian families centered around faith and religion. They were also enterprising and hopeful and over the generations, they were able to obtain their own land to farm. They sold tobacco and cotton as a cash crop and they grew vegetables and raised livestock for personal use. In this way they survived and even thrived over the generations. Even under the best of environmental conditions, farming is a witheringly difficult endeavor. Farmers wake up hours before dawn each day to attack a myriad of chores – milking the cows, tending to seedlings in the greenhouse, tilling the fields, weeding, feeding the livestock and then harvesting and curing tobacco to begin preparing it for the market. There are constant repairs in need of doing. There is constant preparation in building barns and storehouses for crops. A farmer’s work is never done, however, there is no choice but to go to sleep at some point, all to begin again the next morning, steeling yourself against the dark and cold and damp and then enduring the stifling midday heat, the bugs, the insects and the work-interrupting rains. Make no mistake about it, those are when times are ideal. But as many know, the Pee Dee region of South Carolina, where my family is from, lies in a flood plain. When there is a hurricane or a typhoon – as periodically happens in the South – the flood plain gets especially hard-hit. Officials from the South Carolina Coastal Commission, who attended our family gathering, spoke about the catastrophic flooding that can happen in the region – claiming lives, destroying property and ruining crops. Nature can be cruel to man and can take away as easily as it gives. Then there are the man-made disasters we must consider. David Anderson, President of the Anderson Community Bank, who was also in attendance, described how his grandfather started the bank is the midst of the great recession of the 1930s. At that time, most national banks either would not or could not service the rural farm regions of South Carolina. A once thriving tobacco market found itself in dire peril due to a lack of financing. Crop prices plummeted to record lows, forcing many farmers into foreclosure. Market towns suffered as merchants and banks failed. But, the Anderson brothers developed a solution: a bank that would loan money to tobacco warehouse operators to pay farmers for their crops and help tide them over until the crops could be sold at auction in Florence and other major agricultural centers across the state. The Anderson brothers played a critical role in helping farmers recover from the recession and rebuild their businesses. Reflecting on the beauty of the land and my family’s legacy of resilience and strength, I then began to consider some of the difficulties that we have had in our television broadcasting business over the past year. This year was a tough year because as broadcasters we had to negotiate new retransmission agreements with the cable and satellite operators that carry our stations – especially to rural areas where broadcast signals often do not reach. Local news broadcast over cable is a critical lifeline to many rural residents – especially the elderly, who rely upon the news to help them deal with the vicissitudes of climate – rains, tornadoes, floods and heatwaves. During this process, for almost five months, some of our stations were taken off of the cable networks, causing a major decline in our company’s revenue and more importantly, our ability to serve our most vulnerable viewers. But through it all, I remembered the example of our forefathers. Resilience to them was not only a mindset but also a habit. Like them, we had prepared for a downturn in our business because we had aggressively cut costs; we had secured long-term financing on favorable terms that enabled us to keep the lights on and salaries paid even though revenues tanked during the months that we were off-air. We had engendered goodwill in our communities over the years because of our generous charitable contributions: dedicating scholarships to colleges and universities, helping residents affected by floods and providing state-of-the-art clean drinking water facilities to local non-profits. It all came to a head one day when, after we had reached a settlement with the cable operators, one of my consultants who had just found out we were off-air remarked – ‘I had no idea your business was experiencing such a tough time. You never seemed stressed or changed in any way.’ And that said it all, the outward sign of resilience is equanimity. When you know that good and bad times always follow each other – like the seasons – you can prepare for them without much angst. You can even see adversity as a spiritual ‘workout’ of sorts, where striving to overcome life's challenges builds our spiritual muscle. As Marcus Aurelius, the 2nd-century
Roman emperor and philosopher once wrote, resilience is
“the inner master [that], when confronted with
an obstacle, uses it as fuel, like a fire which consumes
things that are thrown into it.” Our American
resilience is deeply rooted in our traditions of struggle
and triumph. It is faithful. It is determined. 2019 is a
year in which we should look back on all we have overcome
and be grateful for how much stronger we became in the
process. Key Survey and
Research Findings
Resiliency role models for people of
any age? Oprah, Ellen DeGeneres, and Nelson Mandela topped
the list — in that order. How to Build Your
Resilience During the COVID-19 Pandemic If a scroll through your social media feed or a quick look at your favorite news outlet each morning triggers sweaty palms, a racing heart, and other feelings of panic, you are not alone. The stress in our country is overwhelming. Though physical health is a top concern as we anxiously check for news on containment of COVID-19, we’re also worrying about job loss, financial fallout, school closures, grief, and uncertainty about what the future holds. There is no playbook for maintaining emotional health during a global pandemic, and people are struggling. In fact, the Disaster Distress Helpline, a federal crisis hotline run by the Substance Abuse and Mental Health Services Administration (SAMHSA), reported a 338 percent increase in call volume from February to March. This represents an 891 percent increase compared with March of last year. An article published April 10 in JAMA Internal Medicine cautions that although the literature on the mental health consequences of epidemics is sparse, large-scale disasters are often associated with increases in post-traumatic stress disorder (PTSD), substance use disorder, a broad range of mental health disorders (including anxiety and depression), domestic violence, and child abuse. Given wide-scale orders for sheltering in place, social distancing, and school and work closures, people of all ages are at risk for loneliness, stress, anxiety, depression, and increased substance abuse. As isolation and disruption to normal daily routines continues, you can expect shifting emotions, feelings of irritability, feelings of disconnection, and other signs of stress and anxiety. There is no easy way through this crisis, but building coping skills and resilience will help you work through the emotional upheaval triggered by COVID-19. Resilience is the process of adapting in the face of adversity, trauma, tragedy, or other significant sources of stress. Becoming resilient helps you work through difficult events, but it also helps you grow and improve your life even in the absence of adversity. Some people refer to resilience as “bouncing back,” but it’s more than that. Being resilient includes learning from past experiences and developing new coping strategies moving forward. Understanding Stress Symptoms The Centers for Disease Control and Prevention (CDC) has warned that the outbreak of COVID-19 can be especially stressful for vulnerable populations, including older adults, children, healthcare workers and first responders, and people with existing mental health problems and substance abuse. The tricky thing about stress is that symptoms can vary among age groups and individuals. Here are some common symptoms of stress in different age groups. Signs of Stress in Older Adults
Signs of Stress in Adults
Signs of Stress in Children and Teens
Key Steps to Building Resilience Like building a muscle, increasing your resilience requires time and dedication. If you don’t put in the work, it might atrophy. People are conditioned to think of resilience as a personality trait (either you have it or you don’t), but this isn’t the case. With intention and practice, you can become more resilient, no matter your age. There isn’t one specific strategy to use to build resilience. It’s a process of establishing connections, coping with stress, adjusting your thought process, and fostering physical wellness. Step 1: Build Your Connections We all need support in life, not just in a crisis. Building a support network of empathetic and compassionate people helps you feel less alone in times of need. Different age groups may try different approaches. Older adults Some older adults are comfortable with technology. If this is the case, many churches, synagogues, and other religious houses of worship are livestreaming services and creating groups on platforms like Zoom. Book groups or other social clubs can also move to Zoom or other online platforms. Video chats with friends and family can help with those connections. If older adults are not comfortable with technology, phone calls and letters are essential. Adults Juggling working from home, handling finances, parenting, and distance learning is difficult and doesn’t leave a lot of time for connecting with other adults. This is particularly true for first responders and other essential workers working long hours to combat this crisis. Make time for video chats to “see” other people and join virtual meetups when you can. While the exhaustion of stress might trick you into thinking that isolating yourself is best, feeling supported by your friends will help you through this difficult time. Children and teens Balance is always important, but now is the time to err on the side of allowing more digital connections so kids can maintain friendships. Some parental supervision may still be necessary, but all age groups can benefit from connecting with friends, family, and classmates they haven’t been able to see in person for a while. Step 2: Learn Coping Skills We all need to hone our coping skills during this crisis so that we can work through the emotional shifts we are likely to experience in an adaptive way. There are a few coping strategies that tend to work across age groups. Deep breathing Deep breathing helps calm the central nervous system and works whether you’re experiencing symptoms of panic or general discomfort. Try square breathing: Trace a square in your palm and count as you draw each line: Inhale, two, three, four; hold, two, three, four; exhale, two, three, four; hold, two, three, four. Meditation and visualization A number of apps can assist with getting into the habit of clearing your mind of stress and visualizing positive outcomes, such as Calm for adults and teens, and Stop, Breathe, Think Kids for little ones. Exercise Daily exercise is a natural stress reliever. Get out for walks or try a livestream exercise class. Step 3: Adjust Your Thought Process It’s difficult to maintain an optimistic outlook when the future feels so uncertain, but positive thinking will help you focus on hope and visualize better times ahead. When you feel flooded with negative thoughts, own them. When you say your thoughts out loud and talk through them, they lose their power. State your negative thought, think about where it stems from, and offer three positive alternative thoughts. Everyone from older adults to very young children can learn to do this. Step 4: Focus on Physical Wellness Stress can hobble your immune system and make you more susceptible to illness. This can, in turn, negatively affect your emotional state. Maintaining your physical wellness plays an important role in building resilience. When you take a whole-person approach to self-care, you care for both your body and your mind. Get back to basics to get into the habit of self-care: Prioritize sleep According to the National Sleep Foundation, people have different sleep needs at different ages, but sleep is universally affected when you're under stress, regardless of your age. Older adults tend to log fewer hours at night (7 to 8 hours), but may need a nap during the day. Adults need 7 to 9 hours, teens need 8 to 10, and children need 9 to 11. Be sure to maintain a consistent sleep schedule during this time. Focus on healthy eating If you crave salty or sweet foods when you're under stress, you’re not alone. Many people want comfort food in times of crisis; but balanced, healthy eating is best for your physical health. Plan ahead for a steady rotation of nutritious meals. Maintain hydration Believe it or not, dehydration can exacerbate symptoms of stress. Be sure to drink plenty of water throughout the day. Remain active In addition to daily exercise, do fun or mentally stimulating activities to enrich your mind and spirit. Play an online card game with a friend or family member, work on a puzzle, spend time gardening, or find another hobby or skill that engages your whole self. You can take small steps each day to
build your resilience muscles, and this will help you
through this crisis as well as any future adversity. |
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