surviving & thriving (resilience)

There is a lot of talk at the moment about the need to 'be resilient' in order to survive and thrive. 

On this page I discuss the concept of resilience and offer evidence-based suggestions to help you survive and thrive in work and life.

The resources on the 'work' section may also help.

Just like creativity and spirituality resilience is difficult to define and it can mean different things to different people.

Resilience 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.

Resilience is a complex and fluid blend of genetic, experiential and learned factors.

Engagement in the arts can help build the resilience of doctors and has been shown to improve the health and wellbeing of patients. 

When thinking more about how you survive and thrive at work 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 wellbeing.  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 on this page are evidence-based and are used regular in our seminars.


You are more likely to survive and thrive in life and at work if you use a set of positive coping strategies. Remembering that they may need to vary, and change through time.

The reason why positive coping strategies work can be explained by our neurophysiology and how we respond to this.

The parasympathetic state of rest and repair should be our body's default position. In this state, we are able to repair our cells, digest our food, respond immunologically to the threat of infection and reproduce. 

Positive coping strategies are important because they enable us to be in a parasympathetic state, gain benefit from the release of positive neurotransmitters and suppress the stress hormone cortisol.

In medicine we often talk to individuals whose symptoms are the result of a reduction in the release of positive neurotransmitters so it can be harder to remember the beneficial effects they have, here is a brief reminder:

Serotonin helps maintain a positive mood and plays an important role in the body's sleep-wake cycle. Levels can be boosted through exercise, connecting with nature, sunlight and the ingestion of foods high in the amino acid tryptophan.

Endorphins give us a short term feeling of wellbeing, easy to understand when you know that they have the same receptors in the brain as opiates. They are released when you undertake cardiovascular exercise, swim or bathe in cold water, sing and interestingly when you eat hot chillis.

Dopamine is often called the 'reward' neurotransmitter, it plays an important role in our motivation and is triggered by undertaking tasks and gaining rewards, or even just the anticipation of them. It's not wholly positive as some people can become addicted to surges of dopamine which can induce risk-taking behaviour such as gambling.

Gaba was not something mentioned when I was at medical school but is responsible for the feeling of calm we experience and plays an important role in helping us sleep and improves our concentration.

Finally, Oxytocin often referred to as the love hormone is released during sex, more so with someone we love, and during physical contact or proximity with people we like or love. It can also be triggered by the warmth of a hot bath.

As we think more about positive coping strategies see if you can link the beneficial impact of the behaviour with the neurotransmitters described above.

There are many resources that discuss coping strategies, we have put together an evidence-based framework to help you think about strategies that might improve your ability to survive and thrive.

I am more likely to survive and thrive if I:

  • Have a strong sense of self
  • Make decisions based on values, not goals
  • Have supportive family & friends
  • Have knowledge of relaxation techniques and allowing time to rest and sleep
  • Invest in my physical health and mental wellbeing
  • Have optimistic thinking
  • Have emotional intelligence 
  • Have a sense of humour and cognitive flexibility
During COVID some of the strategies you rely on to maintain your wellbeing may not be possible, so you may need to think about alternatives. 

Let's look at each of these statements in more detail.


I have a strong sense of self 


Having a personal moral compass is a useful metaphor for understanding this concept.

This also includes:

  • Knowing your values, goals, beliefs
  • Understanding your ideas and thoughts
  • Having many threads to your life e.g. hobbies & passions.
  • Understanding how who you are compared to others

Take a look at Korthagen's Onion Model

a drawing of 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 make decisions based on my values not goals


collage of values

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.


I have supportive family and friends


This statement can be represented as a safety net

 

cartoon picture of 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?

Photo published under CC License


I have knowledge of relaxation techniques and allow time to rest and sleep


Relaxation can occur during many varied activities, context is important, and what is relaxing for one person may be stressful for another. 

When relaxed our parasympathetic nervous system is 'in control' and the physical and psychological experience of 'stress' should lessen.

How do you relax?

Rest is really important to maintaining brain health. There need to be clear boundaries between work and rest, it can be an active process e.g. reading a novel or something less active such as daydreaming or meditation.

Read more about the need for rest in our lives in the book Rest by Alex Soojung-KimPang.

Sleep

'If sleep doesn't serve some vital function, it is the biggest mistake evolution ever made' Allan Rechtschafen.

There is new evidence to explain why sleep is so important for our brain and the overall health of our body. It's not a passive process. When we sleep our brain is busy repairing physical damage and consolidating and generating memories. During sleep the brain's 'glial' cells shrink increasing space between cells allowing the CSF to flow and 'mop up toxins'. You could call sleep the body's maintenance mode.

If you want to read more, Why We Sleep by Matthew Walker has been recommended. 


I invest in my physical health and mental wellbeing


Physical health

Exercise helps maintain both our physical health and sense of wellbeing. For many people it is one of their main positive coping strategies.

Exercise usually causes a surge of endorphins and has been shown to boost serotonin levels. If you remember that opiates bind to the same receptors as endorphins this might help you understand the almost addictive buzz many people feel after exercising 

Investing in your physical health also means eating a balanced healthy diet, looking after your 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?

Mental wellbeing

There is a long list of things you can do to maintain mental wellbeing, I'm just going to highlight two activities that can help.

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 has been shown to ease symptoms of stress, anxiety and chronic pain.

It requires practice and perseverance and involves learning to control your breath. Controlled deep breathing increases our heartbeat variability, this is worth reading more about as new evidence shows this improves morbidity and mortality. 

Meditation and Mindfulness can be learnt by attending a course, reading a book or using an App.

These are some of my favourite resources.

Photo of the magazine breathe
The bimonthly magazine 'Breathe'
Book about Mindfulness
A great guide to Mindfulness & Meditation
logo for the calm app
Learn how to meditate using the Calm app






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 have optimistic thinking


Being optimistic correlates with feeling content with your life.

But did you know that optimism can be learnt and doing this helps you thrive in work and life?

Here are two exercises to promote optimistic thinking.

Is your glass half-full or half-empty?

a half full/empty glass of water

Does it matter what your answer is?

Can you change how you view the glass?

If you are interested in the answer to these questions and learning more about optimism take a look at the work of Martin Seligman.

Reflective exercise

Being able to identify what you do well is a positive coping strategy. At the end of each day identify (and write down) three things you have done well or feel proud of. Evidence shows that doing this even for just a few weeks can help you to thrive.


I have emotional intelligence and cognitive flexibility


I think defining emotional intelligence is challenging.

It's about:

  • Self-awareness
  • Self-management
  • Social awareness
  • Managing relationships

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.

Developing emotional intelligence can help you to survive and thrive.

You can rate your own emotional intelligence online, and learn more about developing it through these resources:

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.

Daniel Goleman is an internationally renowned psychologist and leading thinking about emotional intelligence. This is his definition of EQ:

Emotional intelligence is the ability to perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions so as to promote emotional and intellectual growth.

The School of Life is a global organisation dedicated to developing emotional intelligence. It has some great web-based resources, books and courses. I particularly like How to Develop Emotional Health by Oliver James.

These books are well written but require concentration. For something lighter and just as helpful try The Chimp Paradox and The Silent Guides by Prof. Steve Peters. (and there is a children's version My Hidden Chimp) A chimp is used to excellent effect as a metaphor for helping us understand why how we want to think and behave is often hijacked by other complex emotions.


For something lighter

Take a look at these 'Mood Cards' by Andrea Harrn.

Picture of 'mood cards'

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 and cognitive flexibility


Humour like resilience is also a complex concept to explore and understand.

Most people agree that a good sense of humour (GSOH) is innate and is not something you can easily learn.

So why is it on this list?

Individuals with a GSOH tend to be more resilient. That's because they are more able to see the world from different perspectives and recognise that they may need to adapt themselves to a situation, that's where the term cognitive flexibility comes in (the ability to adapt behaviours in response to changes in the environment)

Humour is a useful strategy for managing stressful situations and reducing conflict.



Some more resources for exploring and building resilience


There are many books written specifically about 'building resilience'.

This Dorling Kindersley publication by psychiatrist Diane McIntosh and psychologist Jonathan Horowitz is a great book about stress and how to manage it while building resilience and surviving and thriving.

It is really well written, up to date; a great book for doctors, students and patients.

I also like this book.

Picture of a book called Resilience

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 vigour from daily setbacks, professional crises, or personal trauma.

Many more books discuss ideas that help build resilience.
Other books to read are;
  • 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 


Hobbies

Undertaking a hobby or learning a new skill whether it is gardening, sewing, painting or learning a new language helps protect our wellbeing. 

The psychologist, Csikszentmihalyi described a phenomenon called deep-play or flow. This is the state you enter when you are completely absorbed by the activity, people who seek out new 'flow experiences'  tend to be happier and report higher satisfaction with life. Being in a state of flow for 30 minutes or more has been shown to reduce your cortisol levels.

There seems to be something protective about having many threads to your life, so you create a rich tapestry, like this one in the picture made by the Indigenous Quechua people in Peru (#womensart).

What are the threads in your life?


Kintsugi

Kintsugi is the Japanese art of repairing broken pottery with 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?

Photo used under CC License


Castell

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

 

Graham Greene Book (A Burnt Out Case)

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.



Updated March 2021