Keywords: resilience, family, friends, adversity, mental health, change
The resilience family tree
In my March blog post I wrote about resilience and how it’s a buzz word within the veterinary profession and by some, has been deemed the way to improve retention of vets and nurses in practice by selecting more resilient students and providing resilience training during their studies. How is resilience measured? I think there’s a tendency to think that the most resilient people are those who are more likely to keep trudging on through exhaustion, illness and unhappiness.
I was thrilled to find a paper titled, “A methodological review of resilience measurement scales” and I was even more delighted to find that it was an open access paper (the little things count!) where the authors concluded that there wasn’t a gold standard approach for measuring resilience (Windle et al., 2011). I wonder if a gold standard psychometric test exists, but I digress! Three of 15 resilience measures scrutinised in the study were considered the best available at that time, were the Connor-Davidson Resilience Scale (25 items), the Resilience Scale for Adults (33 items) and the Brief Resilience Scale (6 items). Below is a word cloud, or in this case a word tree of the items (questions or statements) used in the three scales to give you a flavour of what the items are related to. The more times a particular word is mentioned, the larger the word appears. The word tree demonstrates that within the three resilience scales there were several items that mention family and friends. Of course, there are some items that relate to how one might cope with difficult situations and some about being strong but I was surprised to see that the predominant theme of the items in these three resilience scales were family related.
Small doses of adversity increase resilience
When I was having a mooch around the literature on resilience, I came across a paper published in 2010 titled, “Whatever Does Not Kill Us: Cumulative Lifetime Adversity, Vulnerability, and Resilience” on the results of a longitudinal study involving almost 2,000 people (Seery et al., 2010). This paper reported that individuals with a history of some adversity described better mental health and well-being outcomes than people who experienced more adversity but also those individuals with no experience of adversity. Specifically, U-shaped quadratic relationships indicated that a history of some but low lifetime adversity predicted relatively lower global distress, lower self-rated functional impairment, fewer post-traumatic stress symptoms, and higher life satisfaction over time. Furthermore, people with some prior lifetime adversity were the least affected by recent adverse events. These results suggested that, “in moderation (my bold font), whatever does not kill us may indeed make us stronger.”
Probably one of the most notable difficult experiences I had as a youngster (and one that I’m happy to share very publicly!) was changing secondary schools. It was my choice and when you are spending your maths lessons colouring-in patterns at the age of 13, I wanted to move to a school where I would be challenged. Ha! Be careful what you wish for! Surprise, surprise, I really struggled with maths at my new school and without the fantastic help from my dad, I probably wouldn’t have sat the higher maths paper at GCSE. I remember having to negotiate with the Deputy Headteacher to allow me to sit the higher paper! Did this difficult but ultimately successful experience subconsciously give me the confidence to intercalate after my third year at vet school? Hadn’t thought about it until now! Perhaps if you don’t experience any adversity you don’t get a chance to implement your coping skills but being overwhelmed by difficult circumstances can evoke feelings of not be able to cope with anything.
So it seems that adversity in moderation can be beneficial. Moderation, it’s one of my favourite words… not! You probably won’t be surprised to hear that I like to quantify parameters whenever possible like how many chocolate brownies can I eat a week? How much longer my train is going to be delayed for? How much is my new bike going to cost? Adversity is more difficult to quantify and this was noted in the Seery et al., study. You can count the number of adverse events over a defined period but not all adverse events are created equally. The effect of adverse events will be different for everyone depending on their nature and other things the person is dealing with at the time so I think having open and honest relationships with the people who you work with could help. I appreciate this might be easier said than done depending on how approachable your colleagues are.
When enough is enough
People looking from outside of the situation may use the q-word. Nope not the dreaded word that is banned especially when it’s your night and/or weekend on call but the word, quitter. I didn’t attend my first-year post-graduation reunion dinner because of the fear of being labelled a quitter and a failure. This was back in the day when I thought what other people thought of me was paramount. My decision to leave practice as a new graduate was a painful one and there were many contributing factors. Quitting or giving up on something was commonly taught as negative trait when I was growing up but if only things were so black and white! There are a plethora of reasons why people decide to leave practice or end a relationship or have a change of career. When continuing to persevere is affecting your health and/or you are constantly being met by the same problem, perhaps this would be the time to call it a day and move on? After creating my word tree based on words used in scales for measuring resilience, I’m tempted to say perhaps another good time to move onto something new would be when something is heavily encroaching on your time with family and friends over a prolonged period. I guess it makes sense really because spending less time with family and friends is likely to have a detrimental effect on individuals and potentially will have a knock-on effect on their resilience. Taking on a new challenge whether it’s a new job, learning a new skill or setting yourself a new target within your hobby, you need resilience to keep your eye on the prize and keep pushing through the tougher times. If the tougher times are prolonged and affecting your health so much so that you think you won’t be able to enjoy the prize if/when you achieve it, it might be time to re-evaluate the situation. If you decide to stop working towards a particular goal at that time, there’s nothing stopping you picking it up again at a later date. There are always other options and people to help but they need to know when you need their help so be brave and speak up 😊
I think it’s about time that the confusion between resilience and working to exhaustion needs to be highlighted because constantly being exhausted from overworking is the opposite of being resilient. I am guilty of using overworking as a measure of resilience which might explain why I was surprised to see that family was the most frequently used word in the three resilience scales I looked at. An overworked person is more likely to be teetering on the edge, being battered by curve balls and therefore when a Mildred sized (6kg terrier cross) excrement hits the fan, everything falls to pieces. A rested individual is more likely to be happier, make logical decisions, catch the curve balls, clean the fan and take it in a resilient stride. Employing people who might be deemed ‘resilient on paper’ at a certain point in time doesn’t stop them from potentially reaching their breaking points in the future.
Recently after a long walk in the beautiful Derbyshire countryside, we treated ourselves to a pub lunch. We were incredibly lucky to get a table! When I approached the bar to order, the landlord said he’s happy to serve drinks but he wasn’t taking any food orders for half an hour because the “kitchen staff have had a tough day and could do with a break”. That didn’t bother us in the slightest, we were more than happy to spend the afternoon relaxing in the pub! When writing this blog, this experience popped into my mind because the landlord had recognised that the team of people he works with had been working very hard to meet the demands of fair-weather walkers and they had received an adequate dose of difficulty over the past couple of hours. Life is tough, there’s no denying that. Curve balls will be thrown, stuff will hit the fan and therefore difficult situations and decisions will follow. If there is any way that you can help to moderate the dose or duration of the adversity course for people around you, you could help to build up their resilience. Be kind.
Stacey Blease – a vet thinking aloud
Windle, G., Bennett, K. M., and Noyes, J. A (2011) A methodological review of resilience measurement scales. Health and Quality of Life Outcomes, 9:8. doi:10.1186/1477-7525-9-8
Seery, M. D., Holman, E. A., & Silver, R. C. (2010). Whatever does not kill us: Cumulative lifetime adversity, vulnerability, and resilience. Journal of Personality and Social Psychology, 99(6), 1025-1041. http://dx.doi.org/10.1037