Building and Preserving Individual Resilience - 2014 COSC Symposium

Building and PreservingIndividual Resilience

Eileen Delaney, PhDAsst. Dept. Head, Research Facilitation

Robert D. Gerardi HMCM (SW) MBA/MSHSDepartment Head, Programs

DisclaimerThe opinions expressed in this article are the author's own and do not necessarily reflect the view of the United States Government, the United States Department of Defense, The United States Navy, or The United States Navy Bureau of Medicine and Surgery. 

I am an employee of the U.S. Government. This work was prepared as part of my official duties. Title 17 U.S.C. §105 provides that ‘copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C §101 defines U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

Objectives• Identify Key Concepts of Resilience

• Address Resilience in the Military

• Describe Proposed Navy Resilience Program

• Apply Resilience to the Clinical Setting

Key Concepts of ResilienceDefinition

• Ability to withstand, recover, and grow in the face of challenges, demands, and adversity

Scientific study began in the 1970s

Resilience is rooted in developmental psychology • At first, resilience seen as extraordinary

• Washington Post (1976): “Trouble’s a Bubble to Some Kids”

• Contemporary Psychology (1995): “Superkids of the Ghetto”

• Turns out resilience is “Ordinary Magic”

Key Concepts of ResilienceResilience is rooted in positive psychology

• Scientific study of positive experiences, positive individual traits, and positive institutions

• Grounded in empirical and replicable scientific study• Meta-analyses show that positive emotions optimize health,

subjective well-being, and resilience

• Research highlights• People who express gratitude on a regular basis have better physical

health, progress toward goals, and overall well-being (Emmons & Crumpler, 2000)

• Optimism allows for more opportunities to be seized (Wiseman, 2003)

• Physicians experiencing positive emotion tend to make more accurate diagnoses (Isen, 1993)

Key Concepts of ResilienceResilience is rooted in positive psychology (cont.)

• An absence of negative emotions does not equal well-being

• Negative and positive emotions activate different parts of the

brain

• Positive emotions are more than just happiness• Most common positive emotions: joy, gratitude, serenity, interest,

hope, pride, amusement, pride, amusement, inspiration, awe, love

• Other positive emotions: acceptance, awareness, appreciation,

commitment, courage, forgiveness, humility, patience,

perseverance, service

• Happiness = pleasant feeling + engagement + meaning

Key Concepts of ResilienceResilience can be measured and improved

• 9/11 study of resilience (Fredrickson et al., 2003)• Positive emotions buffered against depression

• Positive emotions mediated resilience

Resilience takes a preventive approach, but can also be utilized when recovering from stress

OSC N170D

Resilience in the MilitaryComprehensive approaches that focuses on mind,

body, spirit and social fitness working together to

address a spectrum of wellness that maximizes

each service member’s personal readiness to hone

the most combat-effective force in the history of the

Department of the Defense.

ReactingReady Injured Ill

Adaptive coping

Optimal functioning

Wellness

FeaturesWell-trained and prepared

Fit and focused

In control

Optimally effective

Behaving ethically

Mild and transient distress or loss of optimal functioning

Temporary & reversible

Low risk for illness

FeaturesIrritable, angry

Anxious or depressed

Physically too pumped up or tired

Reduced self-control

Poor focus

Poor sleep

Persistent and disabling distress or loss of function

Unhealed stress injuries

Mental disorder

TypesPTSD

Major depression

Anxiety

Substance abuse

FeaturesSymptoms and disability persist

over many weeks

Symptoms and disability get worse over time

More severe and persistent distress or loss

Higher risk for illness

CausesLife threat, loss,

inner conflict, wear and tear

FeaturesPanic or rage

Loss of control of body/mind Can’t sleep

Recurrent nightmares/ bad memories

Persistent shame, guilt or blame

Loss of moral values and beliefs

STRESS

Unit Leader Responsibility

Caregiver Responsibility

Individual, Shipmate, Family Responsibility

The Operational Stress Continuum

OSC N170D

NCCOSC Resilience Program

Assessment Training

Command Champion

Evaluation

ReferencesReviewed RAND Report and 32 other research articles associated with resilience• Handbook of Adult Resilience, Reisch, John, PhD, Zautra, Alex, PhD, Hall, Stuart,

PhD, The Guildford Press, 2010

• Optimism Predicts Resilience in Repatriated Prisoners of War: A 37-Year Longitudinal Study, Francine Segovia, Jeffrey L. Moore, Steven E. Linnville, Robert E. Hoyt, and Robert E. Hain, Robert E. Mitchell, Center for Prisoner of War Studies, Navy Medicine Operational Training Center, Pensacola, Florida USA

• Rand Report Review 2011, Meredith LS, Sherbourne CD, Gaillot S, et al. Promoting Psychological Resilience in the U.S. Military. Santa Monica, CA: RAND Center for Military Health Policy Research; 2011.

• Response to Stressful Experiences Scale (RSES), Johnson DC, Polusny MA, Erbes CR, King D, King L, Litz BT, Schnurr PP, Friedman M, Pietrzak RH, Southwick SM. Development and initial validation of the Response to Stressful Experiences Scale. Mil Med. 2011;176(2):161-169.

Pre-decision PROPOSAL

Adaptation of cognitive-behavioral principles addresses: concept of resilience, values, attitudes/beliefs and behaviors

Targets evidence-informed resilience factors:• Optimism

• Flexible Thinking

• Behavioral Control

• Positive Coping

• Control & Acceptance

Individual Resilience Training (IRT)

ValuesPhilosophy, purpose in life and an internal compass that helps keep a person on track

Influence attitudes and beliefs, which then influence behavior  

Can be categorized into self, others and community domains

Being Aware of Your Thoughts

Thoughts/Beliefs

Behavior Feelings

Awareness

An interrelationship of thoughts, feelings and behavior that interact with one another in a feedback loop that can go in both directions  Key element in the model is AWARENESS of one’s thoughts, feelings and behavior

Learning to shift negative thoughts and feelings is the key to strengthening individual resilience through positive behavioral change

• Personalization

• Blaming

• “Should” statements

• Awfulizing beliefs

• All-or-Nothing Thinking

• Overgeneralization

• Catastrophizing

• Mental filtering

• Jumping to conclusions

• Labeling

Negative ThinkingPatterns

• Identifying the “silver lining” of unfortunate or stressful situations

• Attaching meaning to a difficult situation

• Having positive thoughts, beliefs, attitudes, and expectations regarding life

• Develop hope and positive expectations under stress

• Trying to maintain a sense of humor and perspective

• Being flexible about change

Optimism

Flexible ThinkingAbility to consider other alternatives to refrain from rigid beliefs by using: • Positive Reframing

• Thinking about a situation in a different, more positive way

• Changing Unhelpful Thoughts• Helps to successfully deal with any situation by improving

response to adversity, challenges and negative events

• Individuals can remind themselves of the usefulness of moving on from the adversity

Behavior ControlProcess of regulating your thoughts, feelings and behaviors

Reacting in an appropriate and productive manner in any situation

Use of relaxation techniques to stay focused and calm during stressful situations such as:• Meditation (Mindfulness and Relaxation Response)• Visualization• Progressive muscle relaxation• Slow yoga• Tai chi or Qigong• Deep breathing• Prayer

Positive Coping• Coping skills are any solution you use in an attempt

to cope with or solve a problem, or reduce stress

• Taking a positive, active approach to coping, using coping and problem-solving skills

• Positive coping skills are adaptive, functional, helpful and effective

• Negative coping skills are maladaptive, dysfunctional, destructive and ineffective

Positive Coping Life domains that enhance positive coping:

• Physical (Health & Wellness)

• Mental (Psychological & Behavioral)

• Social (Unit & Community Cohesion)

• Spiritual (Higher Purpose)

Positive Coping: Problem-SolvingProblem-Solving:

• Problem-solving is one of the positive coping skills that can bolster resilience

• Negative thought patterns sometimes can make problems seem overwhelming, which can lead to problem-solving inaction

Positive Coping: Problem-SolvingProblem-solving can be broken down into 4 steps:

1.What is the problem?

2.What caused the problem?

3.What is the most appropriate solution for the problem?

4.How am I going to implement the solution?

Control and Acceptance• Realistic appraisal of life situations and

expectations for self and others

• Entails self-confidence and self-efficacy which is the belief and emotional conviction that one can accomplish their goals

• Acceptance of what is beyond control or cannot be changed

• Making the situation better or cope more effectively by changing our thoughts, feelings and behaviors

Pre-decision PROPOSAL

Individual AssessmentSailor Evaluation Tool (SET)

• Self-report and confidential

• Paper-pencil or electronic

• Reliable and valid inventories

• Strength based focus

• Immediate results

• Reports to command leaders

SET MeasuresResilienceCD-RISCRSES

Individual Resilience FactorsFlexible ThinkingControl and ConfidenceOptimismBehavioral ControlPositive Coping

General InformationDemographicsWork/Deployment Variables

Other Related VariablesPerceived StressSocial SupportQuality of LifePersonalityAffectBrief Clinical IndicatorsHealth BehaviorsResilience Practice

Sample Reports

Pilot Studies• Directorate at a Navy Military Treatment Facility

• Navy Amphibious Assault Ship

• Military Family and Support Center (MFSC)

• Recruit Training Command

Resilience in the Clinical SettingCurrent psychotherapy techniques can be supplemented with “positive” interventions• Correct weaknesses + capitalize on strengths

• “How can we reduce suffering?” + “How can we become lastingly happy?”

Building positive emotion, engagement and meaning may counter disorder itself – “undoing effect”

“Broaden-and-Build” Theory

SummaryResilience is needed to maintain a ready fighting force

Resilience can be learned and strengthened

Empirical evidence shows the vast benefits of “positive interventions” and this field is rapidly growing

Thank YouEileen Delaney, PhD

Asst. Dept. Head, Research Facilitation

Robert D. Gerardi HMCM (SW) MBA/MSHSDepartment Head, Programs