Stress and Psychological Resilience

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How the ability to “bounce back” affects our overall well-being

Whether you have consciously thought of it or not, in the last months you have inevitably demonstrated some aspects of emotional and psychological resilience out of sheer necessity.

In February of 2020, nary a handful of us anticipated the blows which March of 2020 would bring. Suddenly, in a matter of days or weeks, the economy had crashed, about 20% of the U.S. was jobless, we were prohibited from visiting the local parks and natural sites, we no longer had a gym or local pub to retreat to, and anyone who was a parent was thrust into the position of managing their child’s schooling at home.

Even greater than these things for some of us was the fear of disease – not only for one’s self, but often more so for the aging or immunocompromised members of our families. On a global, national, and local level we struggled to juggle these newfound challenges, and the majority of us sought out reliable news sources to help inform our direction and decisions much more than ever before. Further complicating the issues since the beginning was the lack of a unified and informed approach to dealing with the problem. Arguably, this may be in part due to its fast-developing nature and other uncertainties surrounding this new disease, but it also is a question that demands explanation from the governing bodies whose utmost interest should be to protect us.

Needless to say, we are in the thick of this, and anything that once was “definite” in our future now is greatly uncertain. So, if you have managed to get up every (or mostly every) day, put on clothing from time to time, and make yourself food, even in doing these very basic things, you have had to demonstrate psychological resilience.

What is Psychological Resilience?

The earliest research on the topic of psychological resilience occurred in the 1970’s. In a study of 698 children who grew up in family environments troubled by discord, divorce, alcoholism, or mental illness, about two-thirds of the children developed similar or related problems as adults. On the other hand, about a third of the children managed to have normal, healthy lives in their later years.^[1] What factors allowed one child to thrive, despite their circumstances, while two of three others ended up following destructive paths, similar to their families? Researchers were then faced with the question: what factors and traits led to the psychological resilience that the healthy children demonstrated?

Psychological resilience is broadly defined as the ability to positively adapt after a stressful or adverse situation. Factors that have been shown to impact psychological resilience include social support,^[2] coping style,^[3] religious beliefs,^[4] mental outlook,^[5] self-care, self-compassion,^[6] flexibility,^[7] independence/self-efficacy, gender, age, race/ethnicity, education, level of trauma exposure, income change, frequency of chronic disease, and recent and past life stressors.^[8],[9]

Studies have looked at the psychological resilience in settings like divorce,^[10] natural disasters,^[11] the loss of a parent or loved one,^[12],[13] the experiences of the military,^[14] chronic disease,^[15] and the response of New York City to the 9/11 terrorist attacks.^[16] Undoubtedly, in years to come, we will see numerous studies that assess the psychological resilience of the individuals working on the frontlines of the COVID-19 pandemic, and how the resilience of each and every one of us has played a role in our mental and physical health outcomes as well. Indeed, such studies already exist from the previous coronavirus epidemic, which we now know as SARS-1.^[17]

Factors shown to positively impact outcomes in survivors of SARS-1 were social support and the absence (or low levels) of disease-related worry.¹⁷ One thing that was seen in some individuals was delayed psychological dysfunction – scores of mental health actually deteriorated more as the months went by, which is the opposite of what is typically seen after a traumatic event. One proposed explanation for delayed psychological dysfunction in some individuals was the high level of worry due to the prediction that there would be a recurrence of the epidemic 12 to 18 months later. Considering that there was delayed psychological dysfunction in a high proportion of survivors, we should certainly be doing everything we can now to prevent this as in our future.

Additionally, more resilient individuals had a higher level of physical functioning initially, which, although not surprising, should make us take note of our own physical health. Although we generally think of the impact psychological resilience has on our mental health, it also affects physical health.^[18] Physical parameters impacted by psychological resilience include chronic pain, blood sugar, markers of disease activity, somatization, and even vulnerability to illness.^{[19],[20],[21],[22]}

In the light of the current pandemic, rather than focusing too much on panic-inducing headlines, it may be of benefit to consider how you can broadly enhance factors that improve your psychological resilience.

Ways to Positively Impact Your Resilience

Social support. It is not without some irony that the very thing that was a key factor in recovery outcomes with SARS-1 is one of the main things that our lives, at least in some ways, have been stripped of: our social connections. By now, fortunately, many of us have adapted to the situation by increasing the frequency of calls or video chats with family and friends, engaging in meetings of supportive groups online, or taking more time to chat with a neighbor on the street. However, as we look to how this pandemic may affect us much longer term, will the things we are doing now be adequate, or is there something more that would bring our lives more normalcy?

Even with social distancing, it isn’t impossible to see and communicate with some people in our social circles. Social distancing can be appropriately applied on a walk in a spacious park or an empty road, with the added bonus that exercise and fresh air offer to our health. When you are out exercising solo in your city, make the extra effort to engage with others you see outside. Even though they aren’t your typical social network, we all are connected really, even more so now in the face of the pandemic.

Disease-related worry. Does your obsessing over medical studies and COVID-19 research really improve your health and the health of those you love? Or would you be better off just consulting a professional you trust concerning how you can best protect yourself against disease? The media can, and will, do everything they can to jump on the bandwagon with disease-related stories, even if they are just one person’s experience, or the results of a small powered study.

Fear about disease is well established to have negative outcomes and promote greater worrying.^{[23],[24],[25]} Anxiety increases our blood pressure,^[26] worsens asthma and other lung conditions,^[27] and adversely affects our immune response to infections.^[28] In individuals with asthma, higher levels of anxiety are independently associated with wheezing, a sensation of chest tightness, and attacks of breathlessness.^[29] So, the message to us all is stop thinking about it and just breathe.

Self-talk. One factor related to the gender impact on resilience is self-talk. In a study looking at the impact of gender on resilience in a population of university students in Turkey, it was shown that males had significantly greater perceptions of themselves as being powerful and a leader, having foresight, and achieving a goal.^[30] Not surprisingly, these attitudes played into their higher levels of resilience. Although gender attitudes in Turkey do not exactly reflect those of other nations, we still see typical masculine norms being associated with standard metrics of higher resilience.^[31]

Sadly, the more generations we go back, the more likely it was that females were given the message that certain things were better jobs for a man: running a company, heading off to war, being the financial provider, and fixing the problem when things go wrong. These historical messages can definitely play into negative self-talk, but what can you do now to defeat it? Can you conquer a project that is disgusting and dirty? Build something complex or fix an appliance? Ask for the raise that you have long deserved? Learn a new sport?

Take advantage of the time at hand and challenge yourself to step out of your comfort zone. Even if you experience defeat, this is an opportunity to adjust your self-talk, and the self-compassion you learn from this has positive effects as well. Learning new skills also enhances your independence and self-agency, which also increases your resilience.

Interestingly, in this time of great crisis, we have seen the greatest success stories from countries like Germany and New Zealand, who under female leadership, are controlling the spread of the disease. It has been argued that the parameters used to assess psychological resilience are wrongly skewed towards positive scoring of what we may think of as a typical male response.^[32] Perhaps the current setting is one where the “most powerful, goal-achieving, strongest leader” are not the characteristics of resiliency that will get us through.

Gratitude and mental outlook. Are you a Nervous or Negative Nellie/Ned, a Sassy Susan/Sam, or a Positive Polly/Paul? Positive emotions have been shown to even help the most resilient of us recover from daily stress.^[33] Studies have shown gratitude or optimism positively affects mood disorders,^[34] cardiovascular health,^[35] pregnancy outcomes, pain, and physical symptoms in general.^[36] What’s good about your life? What or whom do you appreciate? What do you find to be beautiful around you? Take a photo of something that gives you gratitude on a daily basis and start sharing that on social media instead. Starting or ending the day with a gratitude list or expressing thanks to a friend for their care and support are other simply ways to experience gratitude in your day-to-day life.

If you are a person that tends to have higher levels of anxiety and worry, are there things you can you do to translate these feelings into productive behaviors? Whether it be doing things to care for others in your neighborhood, family, or social circle; deepening a spiritual practice; or channeling them into artistic expression; there always is something we can do, and different things resonate with different people.

As there are many factors that positively impact resilience, these are only but a few thoughts to start with. But clearly, given the many challenges coming at us and the indefinite future to come, it is important that we elevate our game strategy a notch or two, as your mental and physical health, even months from now, will thank you.

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