[Introduction to, 9 Keys to Building Resilience: Health Psychology, ©2023]

Resilience. We all want it, or more of it: to recover quickly, to bounce back from adversity, to shrug off stress – to thrive.

The good news is, humans are generally resilient. While certain factors of birth and circumstance may predispose us to it, resilience isn’t only a trait but also a state – and a practice. In their study of 132 adults, Blanke et al. (2023) found that trait resilience, while measurable, did not factor into the successful response to adverse life events; rather, it was the state of resilience as supported by daily life. They further identified specific practices as protective: positive reappraisal (more on that in a moment), mindful attention, and acceptance.

Resilience is a mental robustness or hardiness, if you will, and on a spectrum. In a review of existing resilience research across disciplines of psychology, sociology, health care, education, and philosophy, Daly (2020) identified 3 themes: hardiness, which strengthens our ability to use our existing resources in order to endure hardship; a flexibility that increases our ability to function in positive ways; and, challenges – for without them, we have no opportunity to practice, and to refine, our resilience.

Our resilience can be compromised, however – recovering from and thriving in the face of profound trauma or tragedy is challenging to anyone – and our resources, in need of replenishment. At the time of this writing, the global community has just emerged from a 2-year pandemic test of our resilience, from which we’re still struggling to recover. And in consideration of our climate crisis, we’d all do well to focus on resilience – ours, and that of our planet’s ecosystem.

So how, as an individual, can we boost our resilience? What’s the inoculation against adversity?

Health psychology is a specialty in the behavioral framework, whereby mind and body come together and we utilize principles of psychology for improved overall health. It helps us to become more motivated, to comply with health regimens, and to understand what’s blocking our way. A biopsychosocial model, it also takes into consideration the impact of our support system, our community, and the larger society as a whole. Resilience, therefore, is a primary focus.

One of the common approaches of health psychology is to work with individuals in the promotion of a healthy lifestyle, in order to indirectly impact one’s mental health; as well, the field commonly focuses on risk factors and prevention. In particular, health psychology works to help individuals change those behaviors with negative impact to healthier ones, not only psychological but physical behaviors as well that also negatively affect mental health – such as addiction, eating disorders, or stress management, the latter directly related to resilience. We too, in our final key, will look at ‘lifestyle’ changes that can help to support not only our physical health but our psychological resilience. (More on that soon.)

In a study of the health psychology research, Brivio et al. (2023) found ‘lifestyle’ to be used in 2 ways: behavioral patterns individually chosen but within the parameters of one’s socioeconomic status, a definition also supported by WHO; and, patterns of behavior that adhere to those of one’s social group. While similar, the first places emphasis on individual choice, if limited; the second, on a more collectivist approach of social behaviors. The researchers propose a new model of ‘lifestyle’ integrating both definitions, in which individual meaning, attitudes, and values are integrated with social, historical, and cultural factors, to result in a comprehensive health practice and patterns of healthy behavior.

In this book, we’ll look at 9 keys to building resilience: presence of meaning in one’s life, psychological flexibility, and the necessity of a support system; gratitude, forgiveness, and self-compassion; creativity, mind care (in forms of meditation, mindfulness, and spirituality or presence of meaning), and body care (the contributions of nutrition, exercise, and sleep). We’ll have a bonus chapter, too, on self-motivation.

But before we begin our keys, what can the latest research tell us about resilience?

First: a word about stress. An engineering term (as in, how much stress can this mechanical part take, before it breaks? – or, how much stress can our planet’s ecosystem endure, before it collapses?), it is in fact our response to stress that’s significant. A concept formed by Selye (1950), the stress response is first an emotional reaction, which includes not only the subjective experience itself but also a physiological response, changes in perception and cognition, and a behavioral outcome. In the famous example of Selye, when the tiger jumps into your path, your emotion of extreme fear causes your body to respond instantly, which affects how you perceive and think about the situation – and you either fight, or flee. (Or: you might just freeze in place.)

The key point in terms of our resilience is that, while natural and near-instantaneous, the emotional reaction comes first – and we can engage in daily practices and develop skills that help us to remain calm, and think clearly, in situations of extreme stress – and/or to recover more readily.

I’ve solo traveled to more than 100 countries and lived in several, which, while joyful, has also brought numerous challenges and stressors along the way – and not a few meltdowns. In such initial state of collapse, I allow myself a maximum of 5 minutes for anxiety (fear, panic) and ‘What am I going to do now??’, legitimate emotions after all, then I mentally shake myself and move on to: ‘Now, how do I solve this?’

In my travels, and in a regular pursuit of solo trekking, I’ve inevitably taken many a wrong turn. When I finally realize that I’m not where I intended to be, I may well be frustrated – and, I laugh, shrug my shoulders, look around, and ask myself: Okay, what am I meant to learn here, instead?

When solo trekking along the coast of an island in the Pacific, in what I thought was a simple rainstorm, increasingly high winds and rising tide meant I was ultimately in a position of some danger. Standing on a narrow rock ledge as tides surged to mid-thigh, in their brief receding locating my next safe foot- and hand-hold, one wrong step would have been disastrous. I took many slow, deep breaths and told myself: If I live through this, I’ll get a great story out of it. (It was in fact a typhoon; clearly I survived, and have been telling the tale ever since.)

These are all examples of positive cognitive reappraisal – the conscious reframing of a stressful situation in a direction of problem-solving and learning, often with the added engagement of humor. An emotional regulation strategy, it’s considered by many to be the primary or umbrella mechanism of resilience under which all other forms of tolerance and adaptation are found. In a review of 99 resilience studies (Riepenhausen et al., 2022), it was demonstrated to be a protective factor against the ill effects of stress response, for coping and maintaining wellbeing and functioning, and was further seen to be supported by mindfulness, a secure attachment style, and support both given and received.

We’ll be looking at mindfulness in our 8^th key. Secure attachment, developed in a healthy childhood, refers to the ability to trust others and form relationships; directly related to one’s support system, we’ll explore this in our 3^rd key.

Often, the tiger on the path – or the typhoon – isn’t a sudden event at all, but an ongoing and insidious stressor, such as poverty, systemic racism, chronic illness or disability, or inextricable grief. The risk to one’s psychological functioning is great; we never engage that ‘fight or flight’ function of our autonomic nervous system but instead, it remains half-stimulated over time, never able to discharge and return to neutral as it’s designed to do – and we reach a point of mental and emotional exhaustion, with physical repercussions.

What we mean by ‘adversity’, then, isn’t always so clear, much like the concept of resilience itself; the 2 dominant resilience models, of emotional regulation and of stress management or coping skills, are distinct from one another. This is important for research but not particularly so for our practical application, however, as we build our skills of resilience around coping with stress, and emotional regulation as simply one such coping mechanism, however primary. We build resilience, or emotional hardiness, as preventive or preparatory, to aid recovering and to thrive; we gain coping skills as a palliative approach, one of endurance and harm reduction.

While we know well what it means to recover from an adverse event – to gain strength and lessons from the sometimes profound challenges we must face, and not to be broken in the process, the fundamental definition of resilience – when the adversity is sustained, relentless, and/or systemic, we cannot ‘recover’ but must learn to endure instead. This is where coping mechanisms are especially important; the more we’re able to cope in a way that we might still think of as thriving, to endure despite sometimes severe adversity in ways that allow us to still appreciate, engage in, and enjoy life, the more resilient we surely are. Troy et al. (2023), in identifying the deficiencies in resilience research and comparing these two primary models, have proposed an affect-regulation framework that integrates the two, and can be applied to stressors both acute or intense, and chronic or insidious.

‘Psychological body armor’ is required, a model designed by Everly and colleagues at Johns Hopkins (Kaminsky et al., 2007), by which we aim to develop our resistance and resilience in advance of disaster or other major challenge, and in both proactive and reactive forms. In analysis of this model, Burnett et al. (2019) identified 2 paths to proactive resilience: strong self-acceptance and happiness, or an all-encompassing purpose in life; 2 paths to reactive resilience were also delineated: strong sleep quality, and strong social support with low psychological distress.

And is the concept of resilience consistent across cultures? This would seem obvious – humans are humans, after all – yet resilience is increasingly seen as context-dependent, with diversity across circumstances and cultures. Views on coping and thriving may differ greatly as well; as an example of just one cultural distinction, methods for dealing with adversity in an individualist versus a collectivist culture are likely to be viewed quite differently.

In a review of resilience across cultures, Terrana and al-Delaimy (2023) found 58 unique measurement instruments, with 54 distinct factors for the promotion of resilience. As they were looking at humanitarian measures, they also found a far greater emphasis on trauma and risk, and the healing of and recovery from same, than on resilience as a protective factor. In their attempt to synthesize their findings in order to identify universal features, these researchers identified at the individual level: (1) traits: courage, morality, tolerance, physical health, empathy, and perseverance; (2) beliefs: importance of learning, meaning in suffering, overcoming trauma, challenges as growth opportunities, and purpose in life; (3) competencies: belonging, normalcy, avoidance of negative emotions, responsibility, and gratitude; and, (4) beliefs: political engagement, and expression of positive emotions. At the systemic level, they further identified: (1) familial and nonfamilial sources of support; (2) various accessible public resources; and, (3) cultural values to include religion, family unity, honor, and service.

We do well now to look specifically at family resilience – of the family itself, of how this affects the development of resilience in childhood and adolescence, and of how it contributes to or challenges our resilience in adulthood. Walsh (2021) advocates for a focus on strengthening the family system, as adversity even of just one member indirectly affects the entire family; as well, the strength of resilience in a family system can act as a protective factor in individual adversity. She further provides a framework by which families can be assessed according to their structure, values, challenges, and resources, so that resilience interventions may be more specifically designed, in a collaborative approach that focuses not only on family but also on cultural, community, and spiritual resources.

This is especially important because the development of both coping skills and emotional regulation begin in childhood and extend through adolescence, which for most occurs within a family context (Ronen, 2021), while school constitutes a secondary influence. If the family system doesn’t function in a healthy manner, this can have profound impact on an individual member’s resilience into adulthood – though of course, as adults, we can undertake our own, if belated and more challenging, process of resilience-building. The development of children and adolescents occurs at such a pace as to require great flexibility and adaptability, and a certain measure of resilience will of necessity develop in parallel, almost regardless of family dynamics; as well, children and adolescents often must face their own profound adversities, such as a natural disaster or loss of a parent, and coping skills are essential. Fortunately, not only family but individual traits as well as the influence of school and other community elements also contribute to resilience development.

While research focuses primarily on childhood risk factors, positive childhood experiences, while understudied, provide great contribution to later psychological resilience – especially through the development of self-esteem, as demonstrated in a study of 570 university students during the recent pandemic period (Kocatürk & Çiçek, 2023). Lynch Milder et al. (2023) demonstrated the importance of social support, in the same age cohort of emerging adults, as essential to the resilience especially of those with chronic health concerns, and as predictive for both physical health and emotional wellbeing.

In late life, just as family has often become less available to us, we may become more fragile and vulnerable, facing new health and other challenges, a life stage in which resilience is particularly required. In a study by Ribeiro-Gonçalves et al. (2023), resilience mitigated mental health concerns in older adults, especially with concurrent issues of ageism and loneliness.

Health professionals themselves require vast amounts of resilience, often severely challenged by the potential for burnout. In the recent pandemic – with more such challenges no doubt ahead, in consideration of climate stressors – we all experienced what constitutes a global-scale trauma, having to call upon our resilience reserves. Among the most severely affected were the health practitioners, on the ‘frontlines’ and commonly isolated from family. As demonstrated by al-Qarni et al. (2023), psychological resilience was a mediating factor regarding both trait and state anxiety in health care professionals during this period of crisis, along with age and years of working experience.

Even under normal circumstances, health care professionals endure high levels of stress, expected to give of themselves fully to patients while also needing to protect themselves. Compassion fatigue is all too common – when a person who is emotionally overloaded just can’t bring themselves to care about others anymore – as is burnout, or physical and mental collapse. The development of resilience generally, and specific to compassion fatigue, is therefore recommended for health care providers as well as students preparing to enter a related field (Paiva-Salisbury & Schwanz, 2022).

Principles and approaches of health psychology, then, are applied just as much to health professionals – psychologists, too – as to anyone else, perhaps more so given the stressful nature of their work experience.

Life can be difficult. We all know this – and experienced collectively, in a startling timeline and scale, in the recent pandemic. Resilience is essential. Even for those of us who think we’re resilient, know ourselves to be strong and capable, perhaps have faced major adversity already and found ways not only to survive but to thrive, we still do well to continue building our capacity for resilience – every single day.

And so – on we go. Once more, our 9 keys: presence of life meaning, mental flexibility, social support; gratitude, forgiveness, self-compassion; creativity, mind care, body care. And our bonus: self-motivation.

Shall we begin?

References:

Al-Qarni AM, Elfaki A, Wahab MMA et al. (2023). Psychological Resilience, Anxiety, and Well-Being of Health Care Providers During the COVID-19 Pandemic. Journal of Multidisciplinary Healthcare 16, 1327-1335. https://doi.org/10.2147/JMDH.S403681

Blanke ES, Schmiedek F, Siebert S et al. (2023). Perspectives on resilience: Trait resilience, correlates of resilience in daily life, and longer-term change in affective distress. Stress and Health 39:1, 59-73. https://doi.org/10.1002/smi.3164

Brivio F, Viganò A, Paterna A et al. (2023). Narrative Review and Analysis of the Use of “Lifestyle” in Health Psychology. International Journal of Environmental Research and Public Health 20:5:4427. https://doi.org/10.3390/ijerph20054427

Burnett HJ, Pichot RE, and Bailey KG (2019). An Exploratory Study on Psychological Body Armor. Crisis, Stress, and Human Resilience: An International Journal 1:2, 31-46. https://digitalcommons.andrews.edu/pubs/1150

Daly LM (2020). Resilience: An Integrated Review. Nursing Science Quarterly 33:4, 330-338. https://doi.org/10.1177/0894318420943141

Kaminsky M, McCabe OL, Langlieb AM, and Everly GS (2007). An evidence-informed model of human resistance, resilience, and recovery: The Johns Hopkins’ outcome-driven paradigm for disaster mental health services. Brief Treatment and Crisis Intervention 7:1, 1. https://psycnet.apa.org/doi/10.1093/brief-treatment/mhl015

Kocatürk M and Çiçek İ (2023). Relationship Between Positive Childhood Experiences and Psychological Resilience in University Students: The Mediating Role of Self-Esteem. Journal of Psychologists and Counsellors in Schools 33:1, 78-89. https://doi.org/10.1017/jgc.2021.16   

Lynch Milder MK, Bazier A, Ward S et al. (2023). Resilience, Social Support, and Health in Emerging Adults With and Without Chronic Health Conditions. Emerging Adulthood 11:3, 557-571. https://doi.org/10.1177/21676968221148322

Paiva-Salisbury ML and Schwanz KA (2022). Building Compassion Fatigue Resilience: Awareness, Prevention, and Intervention for Pre-Professionals and Current Practitioners. Journal of Health Service Psychology 48, 39-46. https://doi.org/10.1007/s42843-022-00054-9

Ribeiro-Gonçalves JA, Costa PA, and Leal I (2023). Loneliness, ageism, and mental health: The buffering role of resilience in seniors. International Journal of Clinical and Health Psychology 23:1, 100339. https://doi.org/10.1016/j.ijchp.2022.100339

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Ronen T (2021). The Role of Coping Skills for Developing Resilience Among Children and Adolescents. In: Kern ML and Wehmeyer ML (eds), The Palgrave Handbook of Positive Education. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-64537-3_14

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