[Introduction to, 9 Keys to Mental Self-Care: Health Psychology, ©2023]

Mental wellbeing.

In today’s world, this can seem a luxury. We live at a breathtaking pace, with expectations of 24-hour connectivity and instantaneous response – and a number of ‘slow-down’ movements as forms of protest. There’s much to worry about, and a generally combative atmosphere.

So how can we support our mental wellbeing? Is it possible, when the world at worst seems on fire, and at best is, well, rather intense? Isn’t that just ignoring all that’s wrong, keeping our heads buried in the sand?

It’s not only possible to maintain mental wellbeing; in today’s world it’s essential that we do so. “If you can keep your head when all about you…” (with a tip of the hat to Kipling).

But how?

First, a disclaimer. If you’re in need of psychological care, or already in treatment, these practices aren’t meant as a replacement – but, they can be an enhancement. If you’ve questions about your current mental state, an assessment with a professional may be a good next step.

And: a disclaimer of a very different sort. While this book is focused on mental self-care, I don’t actually believe that there’s any separation of mind and body. In fact, we’ll take a biopsychosocial approach, or nondualist, as the Buddhists would have it (mindfulness being one of our 9 keys): body and mind are one, entirely integrated and all part of one whole, glorious person. You.

So as we focus on mental care, we’ll begin with somatic (body) care in view of this nonseparation — and all within the health psychology framework, with its biopsychosocial model of health and humanity and emphasis on a healthy and supportive lifestyle. (More on this soon.)

The term ‘wellbeing’ gets widely used, to mean many different things. Two types are found in the scientific research: subjective wellbeing, feeling generally okay and content with your life, and psychological wellbeing, specifically mental and emotional strength and capability.

Psychological wellbeing includes having a sense of purpose and meaning in one’s life, good relationships with others, a general feeling of autonomy or self-sufficiency, overall self-acceptance, and a focus on personal growth. Mental health, then, is an integration of psychological, emotional, and social wellbeing. And with psychological wellbeing, the science is clear: we live healthier and longer, with a higher quality of life, contentment, and happiness.

Wellbeing.

In a review of 38 empirical studies conducted 2009-2019 in Australia (Heinsch et al., 2022), protective factors for adult mental health were identified. Such factors were in broad categories of individual attributes, social support, healthy lifestyle, and creative arts – and we’ll see all of these and more in our 9 keys.

Wellbeing science is broadening, as our understanding of what contributes to wellbeing continues to grow (Kemp & Edwards, 2022). Today, the ecopsychology field supports our nature connectedness as an essential component of wellbeing, something our ancestors knew well but in our rush to modernity, we’ve all but lost. The field of positive psychology has also contributed greatly to the concept of wellbeing, in its overarching focus on mental health and the areas and attributes that contribute to it, as has acceptance and commitment therapy, with its emphasis on psychological flexibility.

Let’s return to health psychology now. As mentioned, this specialty embraces the biopsychosocial model of what it means to be a whole human being; many health psychologists include the aspect of spiritual health as well, in an overarching concept of meaning and purpose, which can be found not only via religion but also in sources such as nature, philosophy, and ethical living (Saad et al., 2017). Health psychologists typically work in a hospital or other clinical setting, helping people deal with their fears and resistance when newly diagnosed with a physical illness, for example, or in developing a healthier lifestyle for those struggling with mental illness (Bogucki et al., 2022) – in a firm belief that body and mind affect one another, for good and ill, and thus any treatment plan or general lifestyle approach must be all-inclusive.

What a disservice French philosopher Descartes, and the medical scientific community to follow, did to all of us in this false separation of body and mind; we aren’t just a heart or stomach, or depression or even psychosis, but are whole, integrated human beings – all parts of us in deep communication with one another. Medical science today, of course, is moving ever closer to this model – this return to our roots of nonduality, while indigenous forms of medicine throughout the world, and Asian philosophy in contrast to European, never separated the two.

Physical illness has mental components, and vice versa; even in the ‘somatization’ arena, in which one’s mental condition creates physical symptoms for which there’s no biological basis, this still doesn’t mean it’s only imagination; rather, the mind has contributed to physical illness which is now very real, and the reverse can also be true. Two examples: having to deal with a chronic illness is likely to bring anxiety and/or depression; anxiety and depression are just as likely to develop into physical symptoms such as hypertension or irritable bowel syndrome.

Thus, health psychologists typically have a strong biological background and are well familiar with human anatomy, physiology, and pathology. They bring their skills as a psychologist to bear on such issues as resilience, stress management and coping mechanisms, smoking cessation and other forms of addiction treatment, eating disorders, dealing with chronic illness, enhancing motivation for medical treatment regimens, and generally developing and embracing a healthier lifestyle (Hariharan, 2023). They embrace methods such as Motivational Interviewing or Acceptance and Commitment therapies, as well as positive psychology and the practice of mindfulness – and the applications of exercise, nutrition, and somatic therapies. Health psychology has quite a lot to say, then, about mental self-care.

So would any other branch or specialty of psychology, to be fair – but from the perspective of health psychology and its biopsychosocial (-spiritual) lens, the approach to mental self-care is especially comprehensive.

Let’s take a closer look at that idea of ‘lifestyle’ – a term with a range of meanings. While its popular use is one of engaging in health-promoting practices and avoiding behaviors that represent a health risk, Brivio et al. (2023) argue that this reduces the concept to the behavioral realm while minimizing psychological, identity, and life span aspects. In their review of health psychology research, they identified the ‘lifestyle’ term to have dimensions that are internal (personality, way of thinking, values, interests, and attitudes), external (behavior patterns; social position or status), and temporal (daily practices engaged). They propose that lifestyle as defined by health psychology, is “a system of meanings, attitudes, and values within which the subject acts, which define individual and collective models of health practices within social, historical, and cultural contexts.”

How’s that for comprehensive? In other words: we must consider the healthy lifestyle not only as what we do, but also how we think, who we are, and at what stage of life we find ourselves, alongside contributions of our family, society, and cultural background.

Health psychologists are closely focused on what motivates people to healthier behaviors – or stands in their way. Five health behaviors were analyzed in an extensive review of 633 studies (Perski et al., 2022), to identify psychological and contextual predictors of physical activity, nutrition, alcohol consumption, tobacco smoking, and sexual behavior. Two most common predictors overall were motivation and goals, versus negative emotional states, while social influence and social context / resources were also strongly noted. A total of 1,896 predictors of health behavior were identified.

Similarly, the health psychologist is keenly engaged in patient education about health concerns. In a mega-analysis of relevant research over the past 6 decades, including 40 previously conducted reviews representing 776 studies and 74,947 patients for a broad range of physical and mental conditions, Simonsmeier et al., (2022) demonstrated strong evidence for the effects of patient education on improved health behaviors. Specifically, educating people about their conditions significantly resulted in reduced medication, pain, and clinical visits, and improved outcomes in all areas: physiological, psychological, and functional.

Health psychology research focuses on this enhancement of individual health behavior, and has greatly informed the medical community in this area. In a review of how health psychology research translates into practice, Presseau et al. (2022) identified the impact of such research on practical application or health behavior change interventions, with wide potential for even greater influence. In one such application, a massive open online course [MOOC] on self-care was offered from March 2020 to January 2021 in conjunction with the global Covid pandemic (White et al., 2021). The study had an aim of participants’ health behavior promotion in areas of nutrition, physical activity, and mental health; significant increases in health behaviors were measured on pre-/post-test in outcomes of physical wellbeing, perceived stress, anxiety and depression, and self-efficacy.

Learning about health behaviors and lifestyle can go a long way, it would seem, toward motivation and personal application.

And so, in keeping with the principles and practices of health psychology, and a bio-psycho-socio-spiritual approach, we come to our 9 keys for mental self-care.

We’ll begin by looking at somatic care – how caring for our physical needs complements our mental wellbeing. We’ll look at exercise, nutrition, sleep, and somatic therapies, and how we can better engage these areas. We move from there to our natural home: nature itself, spending time immersed in nature, and the effects of nature connectedness on mental health.

From there, we explore complementary practices of gratitude and self-compassion, for a dual approach in our 3^rd key; this leads us into mindfulness, with its practices of meditation and beyond. Expressive writing is next, as we look at how journal-writing and similar can support mental health, while creative engagement is our 6^th key.

The power of ritual follows, whether religious or secular, for support of psychological wellbeing and personal growth. Our 8^th key is social support, as we look at how important it is to mental wellbeing (for introverts, too!) and how we can better understand and enhance our social capital. And then we reach our final key: prosociality, or contributing to the greater good.

Shall we begin?

References:

Bogucki OE, Kacel EL, Schumann ME et al. (2022). Clinical health psychology in healthcare: Psychology’s contributions to the medical team. Journal of Interprofessional Education & Practice 100554. https://doi.org/10.1016/j.xjep.2022.100554  

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

Hariharan, M. (2023). Evidence-Based Health Care: Contributions of Health Psychology. In, Health Psychology (pp. 3-24). Routledge India.

Heinsch M, Wells H, Sampson D et al. (2022). Protective factors for mental and psychological wellbeing in Australian adults: A review. Mental Health & Prevention 25:200192. https://doi.org/10.1016/j.mhp.2020.200192

Kemp AH and Edwards DJ (2022). Discussion: Broadening the Scope of Wellbeing Science. In: Kemp AH and Edwards DJ (eds), Broadening the Scope of Wellbeing Science. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-18329-4_11

Perski O, Keller J, Kale D et al. (2022). Understanding health behaviours in context: A systematic review and meta-analysis of ecological momentary assessment studies of five key health behaviours. Health Psychology Review 16:4, 576-601. https://doi.org/10.1080/17437199.2022.2112258

Presseau J, Byrne-Davis LMT, Hotham S, et al. (2022). Enhancing the translation of health behaviour change research into practice: A selective conceptual review of the synergy between implementation science and health psychology. Health Psychology Review 16:1, 22-49. https://doi.org/10.1080/17437199.2020.1866638

Saad M, de Medeiros R, and Mosini AC (2017). Are We Ready for a True Biopsychosocial-Spiritual Model? The Many Meanings of “Spiritual”. Medicines 4:4, 79. https://doi.org/10.3390/medicines4040079

Simonsmeier BA, Flaig M, Simacek T et al. (2022). What sixty years of research says about the effectiveness of patient education on health: a second order meta-analysis. Health Psychology Review 16:3, 450-474. https://doi.org/10.1080/17437199.2021.1967184

White MA, Venkataraman A, Roehrig A et al. (2021). Evaluation of a Behavioral Self-care Intervention Administered through a Massive Open Online Course. American Journal of Health Education 52:4, 233-240. https://doi.org/10.1080/19325037.2021.1930616

[Introduction to, 9 Keys to Mindfulness for Health: Health Psychology, ©2023]

Mindfulness is good medicine.

The trait, state, and practice of mindfulness – a ‘mind training’ or heightened awareness of both external and internal stimuli, alongside a system of ethical and compassionate living, emerges from Buddhism with antecedents in its parent religion of Hinduism.

In fact – it’s not necessarily the best translation of the concept.

In Sanskrit, India’s ancient language in which Hindu and Buddhist terminology is rooted, the word we translate into ‘mindfulness’ in English is most closely aligned with ‘remembering’.

I like this. A journal-keeper for 4 decades thus far (and practicing mindfulness for nearly as long), I’ve always begun each new journal with “…remember who i am…” written in isolation on the book’s first blank page.

A remembering, of the true self – and equally, a remembering that ‘self’ is an illusion.

But I digress. (We’ll circle back to this.)

When in English we exhort someone to ‘be mindful’ of something, we’re asking them to take special care. In some ways this does in fact apply to the practice of mindfulness, now also secular, as we take care of our mind, our inner life, our moral and ethical way of being in and interacting with the surrounding world. The mindful state is one of heightened awareness as we pay careful attention to the details of our lives, as we notice all the richness around us – and within us.

Mindfulness, then, is a trait – some people are more naturally mindful, aware, alert, focused – and a state, which we can cultivate and in which we can be, at some times more than others. But most of all: it’s a practice, one that we can integrate into our daily lives seamlessly, and which will bring us a calmness, a contentedness, and a compassionate attitude toward ourselves, others, and the natural world.

Mindfulness is good medicine.

This is also literally intended, as the condition and practice we call mindfulness has enormous health benefits, not only mental-emotional but also physiological – and thus, the premise of this book. More on this in a moment.

But first: what, indeed, is mindfulness?

Focus and notice, as I like to say – but don’t attach.

Of course it’s much more than this, as we’ll see in our 9 keys. At its simplest, however, mindfulness means paying careful and considered – and considerate – attention to our lives, both inner and outer. At the same time, while we recognize our thoughts and emotions as they arise, we also let them drift on by, without a need to latch onto and be defined by them. This is best achieved in a state of ‘beginner’s mind’, one of openness, curiosity, and acceptance, much as we would see in a child.

Rather than, I think, therefore I am (sorry, Descartes), mindfulness is a focus on simply being, and being fully in the present moment. Being, not doing (though we’re not therefore stuck in inaction); existing, fully and richly, rather than striving toward achievement. Self-worth simply as a sentient being, rather than based on anything we’ve done.

And isn’t that already a deeply peaceful place to be?

This doesn’t mean that we no longer have goals – but we learn to have and work toward them in a way that’s separate from our inherent self-worth, that we’ve determined as important to but not defining us. One of the principles of mindfulness that we’ll see in our keys is ‘non-striving’, but we’ll also see that it doesn’t mean inaction; rather, it refers to a way of moving naturally and gracefully through life, going with its flow rather than fighting against it. More on that soon, too.

And how does this fit in with health psychology, our other premise of this book?

My doctoral degree was in health psychology, and mindfulness was an essential part of my professional life. (I say ‘was’ because I’ve just now retired from active practice.) Health psychology, in its biopsychosocial framework, helps people to create and follow healthy lifestyle choices, to discover what best motivates them to adhere to those practices, and to uncover those hidden areas of resistance that may get in their way. It’s easy to see how a mind training such as this can be complementary.

Mindfulness has found its way into many areas of psychology, in fact (Gordon et al., 2021). Buddhism itself, differing from other religions in its absence of deity and emphasis on mental training, has often been compared to psychology, and a Buddhist psychology discipline has emerged. The religion maintains a primary focus on the universal nature of suffering (Four Noble Truths) and its alleviation (8-fold path) toward an ultimate goal of release from suffering (enlightenment); mindfulness is one of the eight practices.

The health psychologist works closely with medical professionals in the hospital or clinical setting, to assist people in complying with medical regimens and adopting healthy behaviors, in order to improve their condition (Bogucki et al., 2022). A practice of mindfulness is therefore commonly found in this setting (Howarth et al., 2019; Porter et al., 2022) – and even applied to health psychologist trainees (Jiménez-Gómez et al., 2022), as well as to physicians (Murphy et al., 2023). Mindfulness does not in any way emerge from the field of health psychology nor is it used by all health psychologists, but it’s often integrated and a good deal of research as well as clinical practice connect the two.

It’s also useful to note that mindfulness, for all its focus on ‘mind’, includes a keen awareness and appreciation of the body, a focus on taking care of one’s body and physical health, and of the mind-body integration – precisely the biopsychosocial model of health psychology.

In my 4 decades of mindfulness practice, I’ve found that, while much of the focus is on the mind, it’s the practices related to my physical body that keep me grounded, connect me to the natural world, and engender a profound wonder at the workings of my body and appreciation for my existence as a creature of nature. Walking meditation, breathing practice, and indeed, a weekly 3-hour walk and meditation while deeply immersed in nature are essential to both my sense of wellbeing and presence of meaning.

Back to mindfulness. The heightened awareness or hyperattention that this practice represents, alongside nonattachment and also nonjudgment as we engage in compassion for ourselves and others, is a form of meta-cognition (Dunne et al., 2019); we observe our own thoughts, as if from a distance. Simultaneously, it represents a meta-emotional intelligence (D’Amico & Geraci, 2023), as we recognize, understand, and let go of emotions without judgment.

Further, a regular practice and state of mindfulness results in time affluence (Schaupp & Geiger, 2022); as we pay careful attention to our lives, time stretches before us and we are rich. That all too common feeling of ‘time flying by’, that increases with age and has reached an breathtaking speed in our technological era – when it’s suddenly New Year’s Eve and you’re sure that last year’s was only yesterday – fades away. When we notice and are fully engaged in our lives, we know keenly the answer to ‘where has the year gone?’ – as our experience of that year was exceedingly full, with many meaningful moments and experiences.

Time slows down. Life is rich and full. Who doesn’t want that?

Ultimately, as we become ever more adept at this mind training, with its aspects of nonattachment, nonjudgment, non-striving, and compassion, we become increasingly aware that we are connected to, even part of, all other sentient beings, what Buddhism calls ‘nonduality’. This term represents a worldview in which all phenomena ‘interexist’; mind and body are one, the individual is one with all humanity, the human species is one with all other species, and so forth – no separation. The self as an independent structure becomes less significant (Buddhism deems ‘self’ an illusion), a concept with which collectivist cultures are inherently familiar and which is innately connected to mental health (Giommi et al., 2023). This ‘quiet ego’ (Liu G et al., 2022), or self-transcendence, is what leads one, then, to enlightenment: knowledge and insight into one’s own mind, deep understanding of one’s interconnectedness, an awareness of universal truth and the nature of reality, wisdom, and contentment.

The science of mindfulness is well established in psychological, behavioral, and neurological models, delineating the effects of a present-moment, nonjudgmental focus on attention, emotion, and biological regulatory processes (Bravo et al., 2022), with a wide range of health outcomes and ongoing research in a multitude of applications. The brain has been mapped via fMRI during mindfulness practice in both clinical and nonclinical settings (Sezer et al., 2022), demonstrating alterations in neural connectivity related to attention control, self-awareness, emotional regulation – and pain relief.

Mindfulness meditation, one of its primary practices, is indeed deemed ‘good medicine’ (Wiles, 2023), promoting the brain’s executive function and salience networks (Bokk & Forster, 2022; Bremer et al., 2022). It’s also useful when practiced by clinicians themselves, improving the function and patient interaction of both physicians (Liu C et al., 2022) and psychotherapists (Shireen et al., 2022). As a model for clinical practice itself, person-centered mindfulness is considered optimal (Koenig, 2023).

The most common form of mindfulness meditation includes a focus on one’s breathing, with an awareness of thoughts and emotions as they arise followed by their gentle release and refocus on breathing. Specific topic foci are also used in meditation; one of the most well-known, meant to generate compassion, is the Loving Kindness Meditation to be later described in full, while another is a meditation on one’s own death, and there are many more. Guided imagery is often used by novice meditators, a type of meditation in which the voice, in person or recorded, of another (or a recording of one’s own voice, for the strongest effect) guides one through a mental image or experience.

Another practice of mindfulness, technically a meditation but applied differently, is the mantram repetition. In this, a key phrase is silently repeated throughout the day to retrain one’s brain and reduce psychological distress, as evidenced in the research review conducted by Schneider et al. (2023). Positive effects of this practice were seen in the recent pandemic (Oman et al., 2022) and in US veterans suffering from posttraumatic stress disorder (Malaktaris et al., 2022), while there are many other applications (Hulett et al., 2022).

The use of one’s breath, as a focal point in meditation and a source of connectedness between mind and body, is a key practice of mindfulness. Body awareness itself, as mentioned, is also significant, including meditations on one’s body, listening to the body’s wisdom, extending compassion to one’s body, and in forms such as walking meditation. The latter can be practiced indoors or outside, and when out in nature, often has a secondary effect of increasing one’s feeling of connectedness to the natural world (Sanyer et al., 2022) which in turn promotes one’s personal health (Djernis et al., 2023). Technology has also contributed to the practice of mindfulness, including apps and podcasts as well as virtual and augmented reality (Harley, 2022).

Let’s return now to our premise of mindfulness for a broad spectrum of health benefits. The practice of mindfulness has been applied not only to health care but also to education, sports, the workplace, prisons, and environmentalism, among others, and nearly 50 years after its introduction to the general public beyond its Buddhist context, remains one of the most actively researched topics. In health care, we see benefits not only for mental health as one might expect, but also a range of physical concerns; as we know that stress contributes to illness both mental and physical, this isn’t particularly surprising.

As we look at some of these benefits, please also note that each research reference included in this section to follow is a very recently conducted review, thus representing multiple studies.

For mental and emotional health, we see cognitive benefits in attention, memory, and other executive function (Melis et al., 2022; Smart et al., 2022), and affective, in reduction of anxiety and depression (Johannsen et al., 2022); benefits are also noted for psychosis (Yip et al., 2022) and for PTSD (Sun et al., 2021; Vadvilavičius et al., 2023). Mindfulness has also been demonstrated to improve resilience (Reitsema et al., 2023; Wexler & Schellinger, 2023) and generally increases one’s subjective wellbeing (Sulosaari et al., 2022). And as we’ve already seen, mindfulness directly increases self-awareness and emotional intelligence, along with goal-setting and motivation.

When it comes to physical health, there’s evidence of benefit to sleep quality (Yang et al., 2022), chronic pain management (Feng et al., 2022; Soundararajan et al., 2022), immunity and inflammation (Dunn & Dimolareva, 2022), cardiac health specifically in lower blood pressure (Conversano et al., 2021), and gastrointestinal health specific to irritable bowel disorder (Balestrieri et al., 2023; Weaver & Szigethy, 2020). Recent research is ongoing in areas of women’s reproductive health including premenstrual syndrome, infertility, pregnancy and childbirth, and menopause. Other ongoing research, not yet conclusive, is being conducted in areas such as diabetes, multiple sclerosis, eating disorders and weight reduction, and substance abuse and addiction. (No doubt there are even more, in this very actively researched topic.)

Correlation between mindfulness and anti-aging is indicated, though also in ongoing research and not yet firmly established; initial studies indicate positive effects on protecting telomeres and reducing background inflammaging, both directly related to cellular aging, while research specific to Alzheimer’s and other dementia is also underway. The evidence is already clear, however, that mindfulness practice can help us to age well, in those previously mentioned areas of cognition, mood, chronic pain, cardiac, gastrointestinal, sleep hygiene, stress reduction and resilience – all of which have direct bearing on how we age.

Thus, the interest of health psychology in the practice of mindfulness is clear: its multiple applications to health both physical and mental, and emphasis on both mind and body, render it one of the most useful approaches to health and motivation to healthy behavior.

Our 9 keys to mindfulness for health, then, are these: attention, present moment, beginner’s mind, nonattachment, nonjudgment, body awareness, non-striving, nonduality, ego transcendence – and, our bonus: enlightenment. These are core areas of mindfulness; we’ll look at each from the perspective of health promotion and wellbeing.

Shall we begin?

.

References:

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Bogucki OE, Kacel EL, Schumann ME et al. (2022). Clinical health psychology in healthcare: Psychology’s contributions to the medical team. Journal of Interprofessional Education & Practice 100554. https://doi.org/10.1016/j.xjep.2022.100554

Bokk O and Forster B (2022). The Effect of a Short Mindfulness Meditation on Somatosensory Attention. Mindfulness 13. https://doi.org/10.1007/s12671-022-01938-z

Bravo AJ, Lindsay EK, and Pearson MR (2022). Nature, Assessment, and Mechanisms of Mindfulness. In: Medvedev ON, Krägeloh CU, Siegert RJ et al. (eds), Handbook of Assessment in Mindfulness Research. Springer, Cham. https://doi.org/10.1007/978-3-030-77644-2_2-1

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D’Amico A and Geraci A (2023). Beyond emotional intelligence: The new construct of meta-emotional intelligence. Frontiers in Psychology 14:1096663. https://doi.org/10.3389/fpsyg.2023 

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[Introduction to, 9 Keys to Addiction Recovery: Health Psychology, ©2023]

Addiction, as anyone who’s ever struggled with it will know, is a tricky business.

In fact, we’re all addicted to something, aren’t we? Whether social media or Netflix binging, coffee or sugar, a hobby — or a certain person, it’s easy to become obsessively attached, and often very challenging to change.

But that’s not quite what we mean when we use the word ‘addiction’.

Whether substance abuse – alcohol, nicotine, or a host of others, street or prescription – or addictive behavior – gambling, shopping, Internet, sex – addiction refers to the target substance or behavior now in control of the person. And that’s when it becomes uncomfortable.

No longer getting high, though always chasing that dragon, one now continues the substance or behavior just to feel ‘normal’. Tolerance, dependence, withdrawal have set in, and you’re not quite in charge of your mind, your body, or your life.

A cascade of consequences often results. You seek assistance, whether in a personal abstinence approach, a supportive friend or 12-step program, or a treatment facility. You manage to free yourself of this burden, now increasingly heavy – only to hear it whispering your name sometime down the road, especially if you find yourself under stress. And the cycle continues.

“Tell me,” the 54-year old former nurse asked me, inebriated but in a moment of crisp clarity, “do you honestly think I have any chance?”

A brittle alcoholic for more than 2 decades, in and out of treatment multiple times, she was familiar to those of us at the hospital and also in the local courts, now brought in by police once more. We were in a small room of the emergency department, she and I, where I was assessing her for admission – one more round of detox followed by the 28-day inpatient rehabilitation program.

And I looked her in eye and with deep compassion and conviction I replied, “For as long as you’re still breathing, Mary, I have to believe that you still have a chance.”

She was admitted to hospital. She successfully completed detox and the 28-day program, and continued to outpatient treatment. Within 3 years she was dead of an alcohol-related accident.

Addiction can be a harsh master.

But there is indeed hope. As long as we’re breathing, there’s still hope. And there are countless stories, all over the world, of those in long-term recovery.

A complex problem, several models of addiction have emerged. For a very long time, addiction was considered a moral issue of faulty character and lack of willpower; we know today that this is simply untrue, though it remains the tendency among those who are judgmental toward or lack compassion for – or have been hurt too many times by – the one who is addicted. A kinder version of the moral / spiritual model suggests that a sense of spiritual connection – whether to religion, philosophy, altruism, or nature, but in any case a sense of deep connectedness and presence of meaning – is missing, and if restored, can be very helpful to recovery. This is embedded in the 12-step programs, and many a religious approach to healing from addiction. Even the shaman, across indigenous cultures, would view addiction as ‘soul loss’ in which part of one’s soul has gone missing, perhaps due to tragedy or trauma; in trance, the shaman enters the spirit world in search of that lost part, in order to retrieve and reintegrate it so that the person may become whole again. This perspective of the model may speak to some who struggle with addiction today.

The biological model of addiction has existed for decades, remaining a primary focus of the medical approach to treatment and also of the 12-step programs; the addicted person is viewed not in terms of character but of someone struggling with a disease, as officially declared in 1956 by the American Medical Association. This too remains valid to a degree, and surely for alcoholism and substance use disorder, there is a very medical detoxification process while medication is often useful for treatment. The self-medication theory falls within this category, as initial substance use or addictive behaviors are seen as an unconscious attempt to relieve an often undiagnosed depression or anxiety, or as a form of pain management. It’s also worthy of consideration that long-term use of any addictive substance creates biological changes in brain and body, which can precipitate a host of other physiological conditions and which makes recovery especially challenging in the extended period of post-acute withdrawal symptoms. Addictive behaviors, too, create neurochemical changes in the pleasure / reward centers of the brain, again quite biological.

The chronic relapsing brain disease model, in the biological model category, suggests that addiction relates to a brain disorder or damage in circuitry of reward, stress, and control, leading to compulsive use irrespective of consequence. The model is based not only on the recidivist nature of addiction but also in its seeming hereditary component, in a view that some are simply more biologically prone to addiction than others by genetic defect. Lie et al. (2022) argue that this model, in ignoring psychosocial aspects and systemic inequities of addiction while emphasizing the addicted person as biologically flawed, serves to further marginalize those with addictions and discounts personal agency. Feingold and Tzur Bitan (2022), in contradiction to this model, propose that, in addition to the self-medication theory of attempts to regulate neurochemical imbalance, substance use may also constitute substitute behavior in which the addicted person is acting out negative emotions in this way; they advocate instead for a biopsychosocial model.

“Will it hurt?” the young man in the rehab unit anxiously asked, as he was about to be taken to the dentist. The social worker accompanying him found this odd; after all, he’d been injecting heroin for some time and living on the street, and surely, he was inured to pain. I later had a heartfelt discussion with her. Yes, the young man had endured his share of pain, but he usually had the heroin to take it away; what’s more, his pain receptor ‘locks’ had been so long blocked by the false ‘key’ of heroin that now they didn’t recognize their natural endorphins, and he was hypersensitive to pain as a result. (Not to mention, he wasn’t sure if he’d be allowed the local anesthetic – and, he was generally anxious and fearful of life at that early point in his recovery.)

The psychodynamic model views addiction as a byproduct of earlier events in one’s life. ‘What happened to you?’ is a question often asked of the person in early recovery, while cognitive-behavioral techniques are typically engaged to help change faulty thought patterns that may have emerged from the earlier events and become entrenched. The abused child, for example, may have learned helplessness and worthlessness, both relieved by the addictive behavior or substance. Self-soothing behavior fits this description, too; early and often repressed negative experiences may make one generally uncomfortable, and the substance or behavior soothes this discomfort. The trauma model (Ross, 2000) we’ll look at later on – which proposes that unresolved trauma, often from childhood, underlies substance use disorder and/or addictive behaviors, as well as most if not all other psychopathology – represents one of the more recent perspectives within this category. Gori et al. (2023) have suggested a comprehensive or ‘vulnerability’ model of addiction to include multiple psychodynamic aspects: childhood trauma, dissociation, and insecure attachment, as in Ross’ trauma model, as well as emotional dysregulation, impulsivity, compulsiveness, and obsessiveness.

“I can’t look at all this pain, oh, I can’t bear it, too much has happened to me, it’s all too much!” the young woman in a hospital detox bed wailed. I stayed with her a while, attempting to comfort her, telling her she didn’t need to look at any of it now – though it was all reemerging at once, as her previous numbing agent of choice leeched from her body – and she was overwhelmed. I quickly taught her a few breathing techniques for managing her emotional overload, then performed acu-detox, five tiny acupuncture needles in each ear, which soothed her as endorphins, and qi, began to flow. Learning a few basic coping skills is essential from the very beginning…as you may not know what painful memories will emerge, once the numbing agent – which also includes alcohol, nicotine, and addictive behaviors – is removed. ‘What happened to you?’ is a critically important question, though only after a base of emotional regulation and coping skills are in place. Meantime, self-compassion also goes a long way toward healing.

An environmental model of addiction suggests external influences, such as addictive behavior or substance use within the family, through the generations, or among peers. A plethora of research over many years has well established the influence of environment on one’s risk for addiction. The surrounding environment is equally influential in one’s recovery, and one is often encouraged to seek out supportive individuals and environments while avoiding those who are more likely to encourage and enable a return to the unwanted addiction; identification of external triggers for relapse is a common emphasis of treatment.

“I relapsed while I was in prison – for possession,” the man casually told me. “Surely drugs are banned in prison?” I replied, not naively, but to draw out his story. “Yeah, well, anything’s possible,” he went on, shrugging his shoulders, “and I was in bad company.” He then told me about his father’s frequent prison stays, and often finding his mother in an alcoholic stupor when he came home from primary school. “I guess I was in bad company from the time I was born,” he lamented.

Finally, we have a biopsychosocial model, which seeks to recognize the value in each of the others and to integrate them for a more comprehensive view of addiction, the person struggling with same, and the support or harm of the surrounding environment. This complexity can make addiction more difficult to treat, however, as recovery must be undertaken on not one but all levels at once. One step further and we have a ‘bio-psycho-socio-spiritual’ approach, perhaps the most holistic, whole-person view of all, and surely the one that this book will take.

We do well also to consider grief and loss in relation to addiction (Furr, 2022). Unresolved grief can surely precipitate the self-medication or self-soothing aspect of substance use or compulsive behavior that ultimately become addiction, an all too common story. Less obvious are the loss of the addiction itself; many a former smoker or alcoholic will readily say he or she misses and grieves the loss of the substance, in their longstanding relationship and the rituals and social life that accompanied it. Going into recovery also typically means no longer socializing with those who are still in active addiction, a major trigger, so it can lead to the loss of relationships as well. Perhaps paradoxically to those who have never experienced addiction, a certain sense of meaning can often be attached to the addictive behavior and/or substance, another aspect of loss when entering recovery – and an unsettling of one’s presence of meaning, which can be a risk factor for relapse in itself. Identity, too, gets wrapped up in the addictive life, and is profoundly shaken when in early recovery. And when in recovery, loss of a loved one or other major loss, in conjunction with the profound loss of the addictive life itself as outlined, presents high risk of relapse (Scroggs et al., 2022) – relapse in itself representing yet another grief or loss, that of recovery itself (Furr, 2022).

Older adults, often at a time of life when grief and loss are paramount, as peers die, chronic illness and loss of ability are present or increasingly likely, loneliness and isolation more common, and mortality looming, there is greater risk of alcohol abuse, or of relapse among those in recovery. In a review of 66 relevant studies, Megherbi-Moulay et al. (2022) determined the significance of biopsychosocial factors such as quality of life, wellbeing, emotional regulation, coping strategies, mood stabilization, and strong social support.

Children are not immune to behavioral addictions, especially internet and smartphone, gaming, and online gambling (Derevensky et al., 2022). Similar to substance use addiction, these addictive behaviors are accompanied by tolerance and withdrawal, emotional dysregulation, alteration in mood with possible disorder, and cycling recovery / relapse.

In an online survey study of 312 participants regarding social network addiction, risk was associated with perceived stress levels, cognitive absorption, and temporal dissociation (Cannito et al., 2022). Online behavioral addictions such as problematic social media use, gambling, gaming, and general Internet use was also studied by Zarate et al. (2023) among 462 adults (69.5% male, 28.5% female). Participants completed questionnaires twice, at a one-year interval; males showed greater tendency toward excessive online gaming, and females for disordered social media use, with associated mood changes and impairment increasing the risk of internet use disorders. And as we might expect, having multiple addictions represents a highly complex condition that is pervasive and persistent. Two large-scale 5-year Canadian adult cohort studies were conducted, within which a subset of 1,088 participants was assessed for substance use and gambling disorders, addictive behaviors, or a combination (Gooding et al., 2022); those with multiple addictions showed significantly greater chronicity.

Recovery capital encompasses the range of attributes and skills, and external support, one may have or can develop to achieve and maintain recovery from addiction. Such supports can be psychological, social, physiological in terms of health practices and lifestyle, and spiritual in a source of meaning. Recovery includes understanding one’s roadblocks or resistances, triggers, and enablers, along with identifying and attempting to resolve underlying trauma or attachment issues, loneliness or isolation, shame or grief. Aging brings its own concerns, and older adults are somewhat at risk for addiction; stress is of course a primary focus, with a need for coping skills and emotional regulation. Much of addictive behavior becomes ritualized, which can feel meaningful, and their loss mourned; filling this socioemotional gap, by replacing those unhealthy rituals with personalized ones for healing, can be beneficial. All of these and more constitute potential recovery capital.

As a model, recovery capital advocates for a self-driven approach to recovery when a reasonable level of such internal and external assets is coupled with a low to moderate addiction; if such assets are low and addiction is severe, professional treatment is recommended instead. When it comes to professional treatment for substance use disorder, Sang et al. (2022) interviewed 3 groups: patients, clinicians, and administrators, regarding effective treatment, challenges, and suggestions for improvement. While there was much agreement across groups, several themes appeared: there was general disagreement among groups regarding medication efficacy; clinicians identified barriers to treatment including trauma, stigma, uniformity of treatment approach, and insurance restrictions, while for patients, greater barriers were in difficulty handling emotions, feeling rushed into therapy, and lack of long-term recovery plans.

As part of recovery capital, we must assess our motivation; Williams (2023) outlines an automatic-reflective motivation framework, automatic in terms of craving, urge, or desire, and reflective as behavioral intention, with a focus on recognizing the former while emphasizing the latter.

Enter the health psychologist.

Health psychology is a specialty that operates within a biopsychosocial framework, often also integrating the spiritual dimension. The psychologist functions as part of a comprehensive medical team to help people deal with biological as well as psychological illnesses. For example, someone with diabetes may need the support not only of a physician and a dietician but also the health psychologist, who can support compliance with medical and dietary changes and also address fears and concerns, and possible concomitant depression or anxiety.

Addiction, including smoking cessation among all others, is a primary area of focus for the health psychologist, under the comprehensive and holistic biopsychosocial model. Other typical areas of focus for the health psychologist include eating disorders, weight control, pain management, chronic illness, unresolved grief, stress management, and preventive medicine including compliance with healthy lifestyle behaviors. Motivational Interviewing, in which aspects of as well as resistance to change are assessed, and mindfulness, a framework that includes meditation, attention, emotional regulation, body awareness, self-compassion, and more, are two primary approaches utilized by the health psychologist.

Above all, health psychology is a wellness and preventive model – while for the person already experiencing addiction, this would apply to the recovery process and prevention of relapse. Wellness can be viewed in terms of physical, mental, emotional, occupational, and spiritual aspects. Mental wellbeing generally includes life satisfaction, subjective happiness, and positive mood, all closely linked to recovery from addiction. In a study of people in recovery, conducted by Schick et al. (2023), happiness and life satisfaction were closely related to coping ability and decreased anxiety, while all three were associated with lower symptoms of depression and distress.

For those challenged by addiction, particular emphasis may be placed on stability and fulfilment; this includes a sense of meaning and purpose in life, work and/or play that feels satisfying, fulfilling relationships, and an increasingly healthy body and home (Delic, 2022). A wellness lifestyle encompasses a balance of healthy habits such as good nutrition, exercise, good sleep hygiene and sufficient rest, productivity and participation in meaningful activities, and social support with regular contact.

Our 9 keys, then, to addiction recovery, are these: meaning-making, or the search for and presence of meaning in one’s life, often equated with spirituality; self-compassion, one of the best medicines, and good to establish very early on; support system, your safety net, its importance and how to have, repair, reestablish one; body care, or the role of body therapies and a healthy lifestyle; mindfulness, a peaceful system of mind training and emotional regulation; the healing of nature, or nature-based therapy; roadblocks to recovery, including resistance, triggers, and enablers; healing the trauma, unresolved grief, and insecure attachment, that may underlie the addiction and contribute to relapse; and, the power of ritual.

Shall we begin?

References:

Cannito L, Annunzi E, Viganò C et al. (2022). The Role of Stress and Cognitive Absorption in Predicting Social Network Addiction. Brain Sciences 12:5:643. https://doi.org/10.3390/brainsci12050643

Delic M (2022). Different dimensions of wellness in drug addiction treatment. European Psychiatry 65:S1, S829-S829. https://doi.org/10.1192/j.eurpsy.2022.2146

Derevensky J, Marchica L, Gilbeau L et al. (2022). Behavioral Addictions in Children: A Focus on Gambling, Gaming, Internet Addiction, and Excessive Smartphone Use. In: Patel VB and Preedy VR (eds), Handbook of Substance Misuse and Addictions. Springer, Cham. https://doi.org/10.1007/978-3-030-67928-6_161-1

Feingold D and Tzur Bitan D (2022). Addiction Psychotherapy: Going Beyond Self-Medication. Frontiers in Psychiatry 13:820660. https://doi.org/10.3389/fpsyt.2022.820660

Furr SR (2022). Is Addiction a Loss to Grieve?. In, Grief Work in Addictions Counseling (pp. 1-17). Routledge. https://doi.org/10.4324/9781003106906-1

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Gori A, Topino E, Cacioppo M, et al. (2023). An Integrated Approach to Addictive Behaviors: A Study on Vulnerability and Maintenance Factors. European Journal of Investigation in Health, Psychology and Education 13:3, 512-524. https://doi.org/10.3390/ejihpe13030039

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Ross CA (2000). The trauma model: A solution to the problem of comorbidity in psychiatry. Richardson, TX, US: Manitou Communications.

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[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

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