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Ann Marie T. Sullivan, M.D., Commissioner
Governor Andrew M. Cuomo

Resilience

Gary L. Spielmann, M.A., M.S.
Director of Suicide Prevention
New York State Office of Mental Health

Resilience and self-help are a cornerstone of the public health strategy to reduce the Number of incidents of suicide in New York. Resilience is the human capacity to deal with, overcome, learn from or even be transformed by adversity (Grotberg: 1999). In the words of a leading neuroscientist:

"People don't come preassembled, but are glued together by life." (LeDoux: 1996).

"Like the immune system, the emotional system evolves continuously, taking experiences and situations and attaching emotional value to them in subtle gradations of risk and reward. Moderate stress enhances learning. Risk is an integral part of life and learning." (Gonzales: 2003)

I. Findings.
Human Nature and Nurture.

Human nature is a powerful source of an individual's ability to cope with challenges and threats. Parents provide their children with genes as well as a home environment, but infants minds come equipped with certain perceptual and behavioral biases. (Restak: 1988) Discoveries in the sciences of mind, brain, genes and evolution challenge the notion that human nature is irrelevant to how we think, feel and behave. Human nature is central to all three, as is human nurture. (Pinker: 2002)

Resilience can be developed through practice, but the extent and depth of its development will depend on individual, genetic and environmental forces Resilience is promoted by external support access to care, aids to autonomy as well as internally, through pride, self-respect and the ability to empathize. Role models are important in the development of resilience at all ages, from early childhood onward.

According to the American Psychological Association (2003), resilience is ordinary, not extraordinary. People commonly demonstrate resilience and bounce back from adversity. The response of many New Yorkers to the September 2001 terrorist attack and individual efforts to rebuild their lives is more typical than atypical. Many people react to traumatic events with a flood of strong emotions and a sense of uncertainty and anxiety. Yet in the face of adversity, most people adapt well over time to even life-altering situations. What enables them to do so? It involves resilience. Being "resilient" does not mean that a person doesn't experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress. Resilience involves behaviors, thoughts and actions that can be learned and developed in anyone. For this reason, promoting resilience is an essential element in New York's suicide prevention strategy. (APA/DHC: 2003)

B. Factors Promoting Resilience

Multiple factors contribute to an individuals resilience. Many studies have shown that a prime factor is having caring and supportive primary relationships within and outside the family. Relationships that create love and trust, provide role models, and offer encouragement, reassurance and hope help to bolster a person's resilience. Resilience is also enhanced by the capacity to make realistic plans and take steps to carry them out and having a positive view of one's own journey.

People react differently to various traumatic and stressful life events. They also use different approaches and strategies. Cultural differences also produce variations and preferences in how individuals communicate and deal with adversity. Growing cultural diversity provides the public with additional approaches to building resilience. (APA/DHC: 2003)

C. Origins of Resilience

According to Grotberg (2002), resilience comes from three sources: external supports that promote resilience; inner strengths that develop over time and sustain those who are dealing with adversities; and interpersonal, problem-solving skills that deal with the actual adversity. Specifically, these are:

I Have
(External Supports)

  1. One or more persons within my family I can trust and who love me without reservation.
  2. One or more persons outside my family I can trust without reservation.
  3. Limits to my behavior
  4. People who encourage me to be independent.
  5. Good role models
  6. Access to health, education, and the social and security services I need
  7. A stable family and community

I Am
(Inner strengths)

  1. A person most people like
  2. Generally calm and good-natured
  3. An achiever who plans for the future
  4. A person who respects myself and others
  5. Empathic and caring of others
  6. Responsible for my own behavior and accepting of the consequences
  7. A confident, optimistic, hopeful person, with faith

I Can
(Interpersonal and problem-solving skills)

  1. Generate new ideas or new ways to do things
  2. Stay with a task until it is finished
  3. See the humor in life and use it to reduce tensions
  4. Express thoughts and feelings in communication with others
  5. Solve problems in various settings academic, job-related, personal and social
  6. Manage my behavior feelings, impulses, acting-out
  7. Reach out for help when I need it. (Grotberg: 2002)

D. Approaches to Teaching Resilience

  1. Penn Resiliency Project (Positive Psychology for Youth Project)

    This Project seeks to prevent depression by giving children the tools to deal with challenges faced in high school and life. It uses psychology, to optimize human potential. Research shows that children who are resilient - who bounce back from problems because they are good at seeing them from multiple perspectives - and who accurately understand their role in the situation fare better after trauma.

    The curriculum flows from an Adversity Belief s and Consequencees model (ABC model). Step A: Identify "push-button adversities", challenges in the important areas of an adolescent's life: school, friendships and family. Step B: Capture what it is you say to yourself in the heat of the moment. This is an internal radio station, often a litany of negative thoughts about the adversity. "I'm not good enough to get the grade." Step C: Examine how inaccurate beliefs shape the quality of your feelings and behavior - the consequences. Did you get the low grade because you were too busy to study during the semester? Will your negative reaction keep you from pursuing a genuine interest? What are the facts surrounding the adversity? Does your reaction reflect them?

    The key to the exercise is connecting Steps B and C and separating fact from interpretation. "It's your beliefs that drive you…They will determine how you respond." If the Project can help children "evaluate themselves more realistically and less harshly, that's important. It can loosen them from the grip of pressures they face." As one of the students put it: "People have the idea that being happy means skipping through the flowers…But happy is being happy with who you are." (Simon: 2004)

  2. Natural Therapy

    Another prominent model promoting resilience involves Natural Therapy. Based on the premise that most of life's difficulties require telling or hearing the truth, this approach teaches that living in a lie eclipses the joy of the world and lowers a person's self-esteem. Concealing lies drain people's energy so they dont have enough strength to do their best. Lies complicate. The truth simplifies. The truth has the power to heal, to protect, to guide. Living in the truth is living free and at one's best. Moreover, the greatest pleasures come only when you are aware of yourself and know your strengths and limitations. Our capacity to enjoy pleasure is limited by our self-acceptance. More than anything else, it is our openness with ourselves that allows us to enjoy life fully. Peace of mind comes with self-acceptance. It is not conferred by achievement, it is the gift you give to yourself. (Viscott: 1996)

  3. Enhancing Natural Support Networks

    Local communities of neighborhoods have individuals, organizations and institutions where people go to seek advice, information and support. These are the resources that influence and enhance community life by providing numerous support mechanisms. Some of the informal community sources of support that regularly dispense advice and support - such as barbers, hairdressers and taxi drivers - are not usually recognized for providing this service, but they constitute part of a natural support network for people around them. Besides providing information, they serve as listening posts that are in themselves a valuable form of natural support.

    These networks are valuable for both individuals and groups affected by a common threat, such as a terrorist attack or natural disaster. While these lay persons typically lack formal training as counselors or providers, they do come in contact with large numbers of the public. As such, they can be a valuable adjunct to a communitys crisis-response. Properly trained,they could help local communities heal themselves. Such a proposal was made to sustain and broaden the community response to the World Trade Center terrorist attack and create what is termed an island of resilience in a sea of uncertainty. In the future, they could be trained and deployed to help individuals become more resilient and able to fend off future disasters and attacks. (Allen: 2003)

  4. Extreme Resilience

What makes a difference in determining whether someone succumbs to a threat or survives? Who lives and who dies? A recent analysis of "deep survival" examined the attitudes and behaviors exhibited by individuals caught in life and death situations in a range of adverse environments. (Gonzales: 2003) The study revealed 12 lessons for prevailing against extreme odds. Such conditions can produce what could be termed "extreme resilience", the ability to think and behave successfully in the clutch of mortal danger.

  1. Perceive, believe (look, see, believe). Extreme survivors rapidly grasp the reality of their situation and acknowledge that everything good or bad emanates from within. Their life is ultimately in their grasp. They move quickly through denial, anger, bargaining, depression and acceptance very quickly.
  2. Stay calm (use humor, use fear to focus). Survivors use fear, turn it into anger, and it motivates them. They understand at a deep level about being cool and are ever on guard against the mutiny of too much emotion. They keep their sense of humor and keep calm.
  3. Think/analyze/plan. Survivors quickly organize, set up routines, and institute discipline. They push away thoughts that their situation is hopeless. They act with the expectation of success.
  4. Take correct, decisive action. Survivors are able to transform thought into action: take risks to save themselves and others and break down large jobs into small, manageable tasks.
  5. Celebrate your successes (take joy in completing tasks). Survivors take great joy from even the smallest successes. Important to sustain motivation, this attitude also prevents the descent into hopelessness.
  6. Count your successes (take joy in completing tasks). This is how survivors become rescuers instead of victims. There is always someone else they are helping more than themselves, even if that someone is not present.
  7. Play (wing, play mind games, recite poetry, count anything). Using deeper powers of intellect can help to stimulate, calm, and entertain the mind. It can also lead to a novel solution to the problem at hand.
  8. See the beauty (remember: it's a vision quest). The appreciation of beauty can relieve stress and create strong motivations, as well as help to take in new information more effectively.
  9. Believe that you will succeed (develop a deep conviction that you will live.) Survivors consolidate their personalities and fix their determination; they admonish themselves to make no more mistakes, to be very careful and to do their very best. They become convinced that they will prevail if they do these things.
  10. Surrender (let go of your fear of dying). Survivors manage pain well. They practice resignation without giving up. It is survival by surrender.
  11. Do whatever is necessary (be determined: have the will and the skill). Survivors have meta-knowledge: they know their abilities and do not over or under-estimate them.
  12. Never give up (let nothing break your support). Survivors have a clear reason for going on. They are not discouraged by setbacks. They come to embrace the world in which they find themselves and see opportunity in adversity. (Gonzales: 2003, 270-274)

II. Action Steps

To build resilience, the following steps are recommended by the American Psychological Association:

  1. Make Connections. Good relationships with other family members, friends, or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper.
  2. Avoid Seeing Crises as Insurmountable Problems. While you can't change the fact that highly stressful events do happen, you can change how you interpret and respond to these events. Look beyond the present for how future circumstances may be a little better.
  3. Accept that Change is a Part of Living. Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter. As one sage observer noted, "freedom is the recognition of necessity."
  4. Move Toward Your Goals. Develop some realistic goals and do something regularly that enables you to move towards your goals, even if it seems like a small accomplishment. Instead of focusing on tasks that seems unachievable, ask yourself, "Whats one thing I know I can accomplish today that helps me move in the direction I want to go?" One step does not make a big difference, but one step taken regularly can.
  5. Take Decisive Action. Act on adverse situations as much as you can. Take decisive action, rather than detaching completely from problems and stresses and wishing they would just go away. Chances are they won't, but decisive action may do just that.
  6. Look for Opportunities for Self-Discovery. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of personal strength, even while feeling vulnerable, an increased sense of self-worth, a more developed spirituality, and heightened appreciation for life.
  7. Nurture a Positive View of Yourself. Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.
  8. Keep Things in Perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.
  9. Maintain a Hopeful Outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.
  10. Take Care of Yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience.
  11. Learn From Experience. Focusing on past experiences and sources of personal strength can help you learn about what strategies for building resilience might work for you.
  12. Stay Flexible. Resilience involves maintaining flexibility and balance in your life as you deal with stressful circumstances and traumatic events.
  13. Complete Your Journey. Developing resilience is similar to taking a raft trip down a river. "Perseverance and trust in your ability to work your way around boulders and other obstacles are important. You can gain courage and insight by successfully navigating your way through white water… You can climb out to rest alongside the river. But to get to the end of your journey, you need to get back in the raft and continue." (APA/DHC: 2003)

References

Allen, John, Enhancing Outreach Efforts through Indigenous Natural Support Networks, (Albany: Project Liberty (OMH), 2003)
American Psychological Association & Discovery Health Channel, (APA/DHC) The Road to Resilience (Washington, DC: 2003)
American Psychological Association, www.helping.apa.org or 1-800-964-2000
Discovery Health Channel, Aftermath: The Road to Resilience (Coping with Tragedy, Learning to Live Again) , Broadcast on August 29, 2003 with an encore presentation on September 11, 2003.
Erikson, Erik, Childhood and Society (New York: WW Norton, 1985)
Gonzales, Laurence, Deep Survival: Who Lives, Who Dies, and Why (New York: W.W. Norton, 2003)
Grotberg, Edith Henderson, Ph.D., How To Deal with Anything, (New York: MJF Books, Fine Communications, 1999)_________________________, A Guide to Promoting Resilience in Children:
Strengthening the Human Spirit (The Hague: Bernard Van Leer Foundation, 1995) (May be downloaded from www.resilnet.uiuc.edu)
__________________________ "International Resilience Research Project,
379-399 . In A.L. Comunian & U. Gielen (eds.) International Perspectives on Human Development (Vienna: Pabst Science Publishers, 2000)
LeDoux, Joseph, The Emotional Brain: The Mysterious Underpinnings of Emotional Life. (New York: Simon & Schuster, 1996)
___________, The Synaptic Self: How Our Brains Become Who We Are (New York: Viking, 2002)
Pinker, Steven, The Blank Slate: The Modern Denial of Human Nature (New York: Viking, 2002)
Restak, Richard, The Mind (New York: Bantam Books, 1988)
Simon, Cecilia Capuzzi, "Adolescents, Sunny Side Up," in Education Life, The New York Times, Section 4A, August 1, 2004.
Viscott, David, M.D., Emotional Resilience: Simple Truths for Dealing with the Unfinished Business of Your Past (New York: Random House, 1996)