Resilience is a complex and fluid blend of genetic, experiential and learned factors.
Just like creativity and spirituality it is difficult to define and it can mean different things to different people.
It can be defined as 'the ability to survive and thrive in an ever changing world'
It is about how you recharge and not how you endure.
It could be described as 'bounce-ability'.
Resilience can be measured.
Resilience can be developed.
Engagement in the arts can help build the resilience of doctors and has been shown to improve the health and wellbeing of patients.
When learning more about resilience it can be hard to know where to start. I think it is helpful to look at key, individual aspects of what can build and maintain resilience. A deeper and broader understanding of resilience can then be developed by putting the individual components together.
Every individual can aim to build their resilience, but the wellbeing and resilience of the medical workforce requires positive change to occur at all levels; the individual, the team, the organisation and the whole culture of medicine.
The creative resources listed here are ones that I have used in my teaching with GPs and Trainee GPs.
This collation of statements is a useful starting point.
I am more likely to be resilient if:
- I have a strong sense of self
- I have a meaningful life (with 'me time)
- I have supportive family & friends
- I have knowledge of relaxation techniques and use them
- I invest in my physical health
- I have optimistic thinking
- I have emotional intelligence and cognitive flexibility
- I have a sense of humour
Lets look at each of these statements in more detail.
I have a strong sense of self and have a meaningful life
The following two exercises can help explore what these statements mean.
Values Vs Goals
Our values equate to the direction of travel of our life.
Our goals are the destination points in our life.
There is evidence to show that being motivated and driven by your values and not your goals can build resilience and contentment with life.
A value might be to work in a profession where you are making a difference to people's lives, a goal might be to be a GP Partner.
Have a go at drawing your own values mind-map.
Korthagen's Onion Model
Korthagen developed this model for the teaching profession, to promote holistic professional development. His model shows that developing professional competencies is one of the outer onion layers that rests on the deeper layers. These deeper layers represent a person's identity and mission, their values and beliefs.
You can read more about the application of his model to learning.
Taking time to consider the questions in relation to your own life can develop a stronger sense of self.
As illustrated and discussed in Williams & Power (2009)
I have supportive family and friends
This statement can be represented as a safety net.
Safety nets are important. They enable us to 'walk the wire' with confidence.
Who is holding your safety net?
You might imagine that the safety net is made up of your coping strategies. What might these be?
Whose safety nets are you holding?
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I have knowledge of relaxation techniques and use them
Relaxation can occur during many varied activities, context is important, and what is relaxing for one person maybe stressful for another. Whatever way we relax our body the benefits arise though the same mechanism which is different and complementary to the benefits to our wellbeing derived from exercise.
Relaxation helps to still the mind and allows the body to be in a state of rest and repair.
In this state the parasympathetic nervous system is 'in control' and the physical and psychological experience of 'stress' should lessen.
How do you relax?
Meditation and Mindfulness
Meditation and Mindfulness are two formal ways of relaxing your body and stilling your mind.
Meditation is an important part of 'being mindful'.
It requires practice and perseverance.
It has been shown to ease symptoms of stress, anxiety and chronic pain.
Meditation and Mindfulness can be learnt by attending a course, reading a book or using an App.
These are some of my favourite resources.
It can be hard to understand why meditation or a mindful approach to life can improve resilience and help manage stress.
Understanding can be gained by thinking about stress from the perspective of our neuroendocrine response. A detailed explanation of this is outside the scope of this website, but in simple terms;
- Our body’s stress response is there to protect us.
- When it is triggered by ‘everyday irritations’ it causes harm.
- The aim of approaches like meditation and mindfulness is to avoid triggering our stress response, by training the brain not to label situations as threats.
- The way we label situations can be a conscious activity, but once we have labelled a situation as a threat our stress response will automatically be stimulated.
Doctors who participate in the courses we run on resilience say that thinking more about the body’s stress response is very useful in helping build their resilience and manage stress.
The Khan Academy’s series of talks on stress are a great way to refresh your knowledge of the body's neuroendocrine response to stress.
I invest in my physical health
It is rarely disputed fact that exercise helps maintain both our physical health and sense of wellbeing. For most people it plays a significant role in how they manage stress.
Exercise causes a release of the neurotransmitters, serotonin, endorphins and noradrenaline. These chemicals are what improves our sense of wellbeing and reduces the symptoms of stress.
Investing in your physical health also means eating a balanced health diet, looking after you body, getting enough sleep and avoiding unhelpful coping strategies such as drinking too much alcohol or using recreational drugs or prescription drugs inappropriately. It also means taking appropriate action if there are physical warning signs in your body that might be the sign of ill health.
Do you invest enough in your physical health?
What might you do better?
I have optimistic thinking
Optimism is linked to being resilient.
Did you know optimism can be learnt and doing this helps build resilience.
Here are two exercises to promote optimistic thinking.
Is your glass half full or half empty?
Does it matter what your answer is?
Can you change how you view the glass?
If you are interested in answering these questions and learning more about optimism take a look at the work of Martin Seligman.
At the end of each day identify (and write down) three things you have done well.
Resilient individuals are better able to identify their strengths and doing this simple exercise can help build your resilience.
I have emotional intelligence and cognitive flexibility
Developing emotional intelligence can help build resilience.
There are many inventories, books and resources to rate your own emotional intelligence and learn more.
Do you understand what 'emotional intelligence' means?
The skills involved in emotional intelligence are self-awareness, self-regulation, motivation, empathy, and social skills.
Many employers now test for emotional intelligence (EQ) and IQ. They often value EQ over IQ because employees with high EQ make better leaders and are more likely to value and promote a positive work environment and culture.
These books are great resources to read.
Emotional Intelligence (Why it can matter more than IQ) Daniel Goleman. Published by Bloomsberry Paperbacks.
Destructive Emotions (How we can overcome them) A Dialoque with the Dalai Lama narrated by Daniel Goleman. Published by Bloomsberry Paperbacks.
The School of Life is a global organisation dedicated to developing emotional intelligence. It has some great web based resources, books and courses.
For something lighter
Take a look at these 'Mood Cards' by Andrea Harrn.
They are based on mindfulness, cognitive therapy and positive psychology. The cards can be used by individuals, in groups or by therapists to help an individual make sense of their moods and emotions. Each card depicts 'a mood' and comes with a series of questions and positive affirmations.
Using the cards to explore 'moods' can help increase Emotional Intelligence.
The cards can be bought from the author on her website themoodcards
I have a sense of humour
Humour like resilience is also a complex concept to explore.
Most people agree that a good sense of humour (GSOH) is innate and is not something you can easily learn.
So why is it in the list of attributes to build resilience?
Firstly, individuals with a GSOH tend to be more resilient.
Secondly, as a reminder that humour is a useful strategy for managing stressful situations.
Finally, it's important to remember that those individuals without a 'GSOH' are less likely to be consistently resilient. This might be seen as a 'red flag'; an individual whois aware they don't have a GSOH might choose to work harder in other areas of their lives to maintain their resilience.
Some more resources for exploring and building resilience
There are many books written specifically about 'building resilience'.
This new publication by psychiatrist Diane McIntosh and psychologist Jonathan Horowitz is a great summary of what stress is and how to manage it while building resilience, surviving and thriving. It's well written, up to date; a great book for doctors, students and patients.
I also like this book.
Published as part of the HBR Emotional Intelligence Series. This copy was purchased at Blackwells.
The book includes the work of Daniel Goleman and other experts in this field, and discusses why some people bounce back with vigor from daily setbacks, professional crises, or personal trauma.
- Thinking Fast and Slow- Daniel Kahnman
- The Chimp Paradox -Prof. Steve Peters
- Who Moved my Cheese?- Spencer Johnson
- Full Catastrophe Living -Jon Kabat-Zinn
- How to have a Beautiful Mind - Edward de Bono
- The Happiness Trap - Russ Harris
- Behave - Robert Sapolsky
- Understanding Beliefs - Nils Nilsson
- The Art of Creative Thinking - Rod Judkins
- The Five Point Rescue Plan - Karen Forshaw and Jaimee Wylam
- Seven Habits of Highly Effective People - Stephen Covey
The Resilience Prescription
Dr Dennis Charney is a leading expert in the neurobiology and treatment of mood and anxiety disorders. His 'Resilience Prescription' is based on his research into human resilience.
Take a look at his 'prescription'.
Now you have read through the resources on the site, what might you prescribe yourself?
Art resources to prompt further discussion about resilience
Kinsugi is the Japanese art of repairing broken pottery with a precious metal. It treats the breakage and repair as an important part of the history of the object, one that retains the beauty of the pottery.
It is based on the philosophy of 'wabi-sabi' - the acceptance of transience and imperfection.
How might this ancient art help you understand the concept of resilience?
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How might this Spanish Human Tower help you understand the difference between personal and organisational resilience.
Photo used under CC License
A Burnt Out Case by Graham Green (1960)
Published by Vintage Classics
Have you ever wondered where the term 'burnt-out' originated? This 1960s novel offers one explanation.
Are there other explanations you have heard about?
There are inventories for measuring 'burn-out'. The Oldberg Inventory is one of the most frequently used and can be accessed for free through the BMA.
Please look under 'tutorial ideas' for more teaching ideas.
Updated 5 May 2019