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An overview of the key concepts of resilience, resilience in the military to include a description of the Navy Resilience Program, and how to apply resilience in a clinical setting.
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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