Cultivating Resilience in the Face of Adversity
Lila J. Finney Rutten, PhD, MPH✉, SBM Member Delegate; and Amit Sood, MD, MSc
Stress and Resilience
Data from more than 135,000 interviews conducted by Gallup Poll in 2017 reveal significant decline in well-being among U.S. adults.1 Indeed, feelings of stress, loneliness, and depression are pervasive in the U.S.2 All of us face stress and adversity throughout our lives, but some of us seem to manage it with greater grit, and recover from it faster and more fully. This ability to withstand and recover from adversity and derive personal growth from challenging life events is called resilience.2-9
Four domains of resilience have been described.7,10 Physical resilience is characterized by good health, strength, and the ability to quickly recover from illness or injury. Cognitive resilience is the ability to maintain focus and judgment and make good decisions under stress. Emotional resilience is characterized by emotional stability and the ability to quickly recover from negative emotions. Spiritual resilience can be described as having a sense of higher purpose, living a principled life, and having the ability to maintain an altruistic perspective when faced with adversity. Integration of these domains provides a useful construct for individuals to thrive personally and professionally.
A large body of research has emerged examining the association between resilience and health, wellbeing, and longevity.9-21 This research points to important ways in which all of us can cultivate our own resilience.7,10-18
Physical resilience can be nurtured through healthy lifestyle choices including participating in regular physical activity, eating a healthy diet, getting adequate sleep, and effectively managing stress.7,10
Cognitive resilience can be fostered through attention training practices.7,10 Bringing mindfulness and intentionality to your attention can help reduce internal distractions and worries and soften judgment of or reactivity to others. For example, by taking back control of your attention, amidst adversity, you may more easily be able to guide your thoughts toward the actionable, while keeping hope and positivity. Similarly, by training yourself to practice kind attention, you may more easily diffuse anger.
Emotional resilience can be fostered through mindfulness practices aimed at cultivating gratitude, compassion, acceptance, meaning, and forgiveness. 7,10
Making efforts to recognize valued aspects of one’s experience has been shown to improve mood, enhance wellbeing, improve self-esteem, and lower risk of post-traumatic stress disorder.22-24
Compassion refers to the ability to relate to others in a way that is empathetic, while being mindful of our shared human struggles, and the desire of belonging and safety. Cultivating compassion lowers stress, decreases pain, improves immune function, decreases length of acute illness, and improves satisfaction with healthcare.25-27 Compassion can be enhanced through recognizing and validating others’ struggles, delaying negative judgment, and identifying a sense of connectedness to those who are struggling. Compassion toward self is as important as compassion toward others.
Acceptance is the ability to recognize and cope with that which you cannot control. Acceptance requires openness to experiences as they are, allowing for imperfections, set-backs, and failure. Acceptance isn’t giving up; instead acceptance is empowered engagement. Research has demonstrated that acceptance is associated with improvements in quality of life, greater coping ability, better control of anxiety and depression, decreases in chronic pain, and improvement in chronic disease management 28-30 Acceptance can be cultivated through: developing rational expectations; seeking meaning in challenging aspects of your relationships; and considering the context of others’ behaviors while valuing their strengths.
Meaning is attached to consideration of one’s identity, existence, and place. Finding meaning is associated with reductions in negative affect, improved quality of life and coping skills, improved physical health, and increased survival.31,32 Experientially, meaning is often derived from our sense of belonging (relationships), purpose (work), and understanding (spirituality).7
Forgiveness is a conscious choice to let go of anger and resentment. It does not mean denial or justification for wrong doing. It is a purposeful choice to free up your energy for more positive experiences. Forgiveness is associated with improvements in psychological, social, and positive health outcomes33-37 Practice patience with the process of forgiveness as it may take time and repeated effort. Draw upon compassion for others recognizing that everyone struggles in their own unique way. Accept imperfections in yourself and others, and adjust your expectations accordingly.
Try these easy practices to foster emotional resilience.
Spiritual resilience can be pursued through varied paths including service, meaningful work, attending to nature, intentional focusing on the moment, tending to relationships, and through specific faith-based practices.7,10 Practices and experiences that allow you to get in touch with that which is meaningful and serves your greater sense of purpose will nurture your spirituality.
Meet Yourself With Loyalty
Reflect on the ways you may benefit from efforts to nurture your own resilience. Show yourself compassion, acceptance, and forgiveness as a starting point for developing new practices and perspectives that will help you build reserve for life’s inevitable challenges and losses.
- Witters D. Americans' Well-Being Declines in 2017. 2017; https://news.gallup.com/poll/221588/americans-declines-2017.aspx. Accessed June 19, 2018.
- Sood A. Executive Resilience. Global Center for Resilience and Wellbeing
- Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82.
- Masten AS, Obradovic J. Competence and resilience in development. Ann N Y Acad Sci. 2006;1094:13-27.
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- Windle G, Bennett KM, Noyes J. A methodological review of resilience measurement scales. Health Qual Life Outcomes. 2011;9:8.
- Sood A. The Mayo Clinic Guide to Stress-Free Living. Boston, MA: Da Capo Press; 2013.
- Windle G. What is resilience? A review and concept analysis. Reviews in Clinical Gerontology 2011;21(2):152-169
- Leppin AL, Bora PR, Tilburt JC, et al. The efficacy of resiliency training programs: a systematic review and meta-analysis of randomized trials. PLoS One. 2014;9(10):e111420.
- Sood A. The Mayo Clinic Handbook for Happiness: A 4-Step Plan for Resilient Living. Boston, MA: Da Capo Press; 2015.
- Dyrbye LN, Shanafelt TD, Werner L, Sood A, Satele D, Wolanskyj AP. The Impact of a Required Longitudinal Stress Management and Resilience Training Course for First-Year Medical Students. J Gen Intern Med. 2017;32(12):1309-1314.
- Magtibay DL, Chesak SS, Coughlin K, Sood A. Decreasing Stress and Burnout in Nurses: Efficacy of Blended Learning With Stress Management and Resilience Training Program. J Nurs Adm. 2017;47(7-8):391-395.
- Stonnington CM, Darby B, Santucci A, et al. A resilience intervention involving mindfulness training for transplant patients and their caregivers. Clin Transplant. 2016;30(11):1466-1472.
- Chesak SS, Bhagra A, Schroeder DR, Foy DA, Cutshall SM, Sood A. Enhancing resilience among new nurses: feasibility and efficacy of a pilot intervention. Ochsner J. 2015;15(1):38-44.
- Sharma V, Sood A, Prasad K, Loehrer L, Schroeder D, Brent B. Bibliotherapy to decrease stress and anxiety and increase resilience and mindfulness: a pilot trial. Explore (NY). 2014;10(4):248-252.
- Leppin AL, Gionfriddo MR, Sood A, et al. The efficacy of resilience training programs: a systematic review protocol. Syst Rev. 2014;3:20.
- Loprinzi CE, Prasad K, Schroeder DR, Sood A. Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer. 2011;11(6):364-368.
- Sood A, Prasad K, Schroeder D, Varkey P. Stress management and resilience training among Department of Medicine faculty: a pilot randomized clinical trial. J Gen Intern Med. 2011;26(8):858-861.
- Bennett KM, Windle G. The importance of not only individual, but also community and society factors in resilience in later life. Behav Brain Sci. 2015;38:e94.
- Windle G. The contribution of resilience to healthy ageing. Perspect Public Health. 2012;132(4):159-160.
- Almedom AM. Resilience research and policy/practice discourse in health, social, behavioral, and environmental sciences over the last ten years. Afr Health Sci. 2008;8 Suppl 1:S5-13.
- Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003;84(2):377-389.
- McCullough ME, Emmons RA, Tsang JA. The grateful disposition: a conceptual and empirical topography. J Pers Soc Psychol. 2002;82(1):112-127.
- McCullough ME, Tsang JA, Emmons RA. Gratitude in intermediate affective terrain: links of grateful moods to individual differences and daily emotional experience. J Pers Soc Psychol. 2004;86(2):295-309.
- Selph RB, Shiang J, Engelberg R, Curtis JR, White DB. Empathy and life support decisions in intensive care units. J Gen Intern Med. 2008;23(9):1311-1317.
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- Joans WB, Crawford CC. Healing, intention, and energy medicine. . New York, NY: Livingstone; 2003.
- Low CA, Stanton AL, Bower JE. Effects of acceptance-oriented versus evaluative emotional processing on heart rate recovery and habituation. Emotion (Washington, DC). 2008;8(3):419-424.
- Kranz D, Bollinger A, Nilges P. Chronic pain acceptance and affective well-being: A coping perspective. Eur J Pain. 2010;14(10):1021-1025.
- Ford BQ, Lam P, John OP, Mauss IB. The Psychological Health Benefits of Accepting Negative Emotions and Thoughts: Laboratory, Diary, and Longitudinal Evidence. J Pers Soc Psychol. 2017.
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- Taylor EJ. Transformation of tragedy among women surviving breast cancer. Oncol Nurs Forum. 2000;27(5):781-788.
- Wilson T, Milosevic A, Carroll M, Hart K, Hibbard S. Physical health status in relation to self-forgiveness and other-forgiveness in healthy college students. J Health Psychol. 2008;13(6):798-803.
- Friedberg JP, Suchday S, Shelov DV. The impact of forgiveness on cardiovascular reactivity and recovery. Int J Psychophysiol. 2007;65(2):87-94.
- Friedberg JP, Suchday S, Srinivas VS. Relationship between forgiveness and psychological and physiological indices in cardiac patients. Int J Behav Med. 2009;16(3):205-211.
- Carson JW, Keefe FJ, Goli V, et al. Forgiveness and chronic low back pain: a preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress. J Pain. 2005;6(2):84-91.
- Hansen MJ, Enright RD, Baskin TW, Klatt J. A palliative care intervention in forgiveness therapy for elderly terminally ill cancer patients. J Palliat Care. 2009;25(1):51-60.