70 days of lockdown and psychological resilience

70 days of lockdown and psychological resilience

Whether you have consciously thought of it or not, in the last 70 days you have inevitably demonstrated some aspects of emotional and psychological resilience out of sheer necessity.

Back in February of 2020, no one anticipated what the last few months would bring. Suddenly, in a matter of days or weeks, our economy had nose-dived, millions of us furloughed, we were prohibited from visiting the local parks and natural sites, we no longer had a gym or local pub to retreat to, and anyone who is a parent was thrust into the position of managing their child’s schooling at home.

Even greater than these things for some of us was the fear of disease – not only for one’s self but often more so for the ageing or immunocompromised members of our families. On a global, national, and local level we struggled to juggle these newfound challenges, and the majority of us sought out reliable news sources to help inform our direction and decisions much more than ever before. Further complicating the issues since the beginning was the lack of a unified and informed approach to dealing with the problem. Arguably, this may be in part due to its fast-developing nature and other uncertainties surrounding this new disease, but it also is a question that demands an explanation from the governing bodies whose utmost interest should be to protect us.

Needless to say, we are still in the thick of this, and anything that once was “definite” in our future now is greatly uncertain. So, if you have managed to get up every (or mostly every) day, put on clothing from time to time, and make yourself food, even in doing these very basic things, you have had to demonstrate psychological resilience.

What is Psychological Resilience?

The earliest research on the topic of psychological resilience occurred in the 1970s. In a study of 698 children who grew up in family environments troubled by discord, divorce, alcoholism, or mental illness, about two-thirds of the children developed similar or related problems as adults. On the other hand, about a third of the children managed to have normal, healthy lives in their later years.[1] What factors allowed one child to thrive, despite their circumstances, while two of three others ended up following destructive paths, similar to their families? Researchers were then faced with the question: what factors and traits led to the psychological resilience that the healthy children demonstrated?

Psychological resilience is broadly defined as the ability to positively adapt after a stressful or adverse situation. Factors that have been shown to impact psychological resilience include social support,[2] coping style,[3] religious beliefs,[4] mental outlook,[5] self-care, self-compassion,[6] flexibility,[7] independence/self-efficacy, gender, age, race/ethnicity, education, level of trauma exposure, income change, frequency of chronic disease, and recent and past life stressors.[8],[9]

Studies have looked at the psychological resilience in settings like divorce,[10] natural disasters,[11] the loss of a parent or loved one,[12],[13] the experiences of the military,[14] chronic disease,[15] and the response of New York City to the 9/11 terrorist attacks.[16] Undoubtedly, in years to come, we will see numerous studies that assess the psychological resilience of the individuals working on the frontlines of the COVID-19 pandemic, and how the resilience of each and every one of us has played a role in our mental and physical health outcomes as well. Indeed, such studies already exist from the previous coronavirus epidemic, which we now know as SARS-1.[17]

Factors shown to positively impact outcomes in survivors of SARS-1 were social support and the absence (or low levels) of disease-related worry.17 One thing that was seen in some individuals was delayed psychological dysfunction – scores of mental health actually deteriorated more as the months went by, which is the opposite of what is typically seen after a traumatic event. One proposed explanation for delayed psychological dysfunction in some individuals was the high level of worry due to the prediction that there would be a recurrence of the epidemic 12 to 18 months later. Considering that there was delayed psychological dysfunction in a high proportion of survivors, we should certainly be doing everything we can now to prevent this as in our future.

Additionally, more resilient individuals had a higher level of physical functioning initially, which, although not surprising, should make us take note of our own physical health. Although we generally think of the impact psychological resilience has on our mental health, it also affects physical health.[18] Physical parameters impacted by psychological resilience include chronic pain, blood sugar, markers of disease activity, somatization, and even vulnerability to illness.[19],[20],[21],[22]

In the light of the current pandemic, rather than focusing too much on panic-inducing headlines, it may be of benefit to consider how you can broadly enhance factors that improve your psychological resilience.

Ways to Positively Impact Your Resilience

Social support

It is not without some irony that the very thing that was a key factor in recovery outcomes with SARS-1 is one of the main things that our lives, at least in some ways, have been stripped of: our social connections. By now, fortunately, many of us have adapted to the situation by increasing the frequency of calls or video chats with family and friends, engaging in meetings of supportive groups online, or taking more time to chat with a neighbour on the street. However, as we look to how this pandemic may affect us much longer term, will the things we are doing now be adequate, or is there something more that would bring our lives more normalcy?

Even with social distancing, it isn’t impossible to see and communicate with some people in our social circles. Social distancing can be appropriately applied on a walk in a spacious park or an empty road, with the added bonus that exercise and fresh air offer to our health. When you are out exercising solo in your city, make the extra effort to engage with others you see outside. Even though they aren’t your typical social network, we all are connected really, even more so now in the face of the pandemic.

Disease-related worry

Does your obsessing over medical studies and COVID-19 research really improve your health and the health of those you love? Or would you be better off just consulting a professional you trust concerning how you can best protect yourself against disease? The media can, and will, do everything they can to jump on the bandwagon with disease-related stories, even if they are just one person’s experience or the results of a small powered study.

Fear about disease is well established to have negative outcomes and promote greater worrying.[23],[24],[25] Anxiety increases our blood pressure,[26] worsens asthma and other lung conditions,[27] and adversely affects our immune response to infections.[28] In individuals with asthma, higher levels of anxiety are independently associated with wheezing, a sensation of chest tightness, and attacks of breathlessness.[29] So, the message to us all is, stop thinking about it and just breathe.

Self-talk

One factor related to the gender impact on resilience is self-talk. In a study looking at the impact of gender on resilience in a population of university students in Turkey, it was shown that males had significantly greater perceptions of themselves as being powerful and a leader, having foresight and achieving a goal.[30] Not surprisingly, these attitudes played into their higher levels of resilience. Although gender attitudes in Turkey do not exactly reflect those of other nations, we still see typical masculine norms being associated with standard metrics of higher resilience.[31]

Sadly, the more generations we go back, the more likely it was that females were given the message that certain things were better jobs for a man: running a company, heading off to war, being the financial provider, and fixing the problem when things go wrong. These historical messages can definitely play into negative self-talk, but what can you do now to defeat it? Can you conquer a project that is disgusting and dirty? Build something complex or fix an appliance? Ask for the raise that you have long deserved? Learn a new sport?

Step out of your comfort zone

Even if you experience defeat, this is an opportunity to adjust your self-talk, and the self-compassion you learn from this has positive effects as well. Learning new skills also enhances your independence and self-agency, which also increases your resilience.

Interestingly, in this time of great crisis, we have seen the greatest success stories from countries like Germany and New Zealand, who under female leadership, are controlling the spread of the disease. It has been argued that the parameters used to assess psychological resilience are wrongly skewed towards positive scoring of what we may think of as a typical male response.[32] Perhaps the current setting is one where the “most powerful, goal-achieving, strongest leader” are not the characteristics of resiliency that will get us through.

Gratitude and mental outlook

Positive emotions have been shown to even help the most resilient of us recover from daily stress.[33] Studies have shown gratitude or optimism positively affects mood disorders,[34] cardiovascular health,[35] pregnancy outcomes, pain, and physical symptoms in general.[36] What’s good about your life? What or whom do you appreciate? What do you find to be beautiful around you? Take a photo of something that gives you gratitude on a daily basis and start sharing that on social media instead. Starting or ending the day with a gratitude list or expressing thanks to a friend for their care and support are other simple ways to experience gratitude in your day-to-day life.

If you are a person that tends to have higher levels of anxiety and worry, are there things you can you do to translate these feelings into productive behaviours? Whether it be doing things to care for others in your neighbourhood, family, or social circle; deepening a spiritual practice; or channelling them into artistic expression; there always is something we can do, and different things resonate with different people.

As there are many factors that positively impact resilience, these are only but a few thoughts to start with. But clearly, given the many challenges coming at us and the indefinite future to come, it is important that we elevate our game strategy a notch or two, as your mental and physical health, even months from now, will thank you.

References

[1] Werner EE. The children of Kauai: resiliency and recovery in adolescence and adulthood. J Adolesc Health. 1992 Jun;13(4):262-8.

[2] Somasundaram RO, Devamani KA. A comparative study on resilience, perceived social support and hopelessness among cancer patients treated with curative and palliative care. Indian J Palliat Care. 2016 Apr;22(2):135.

[3] Beasley M, et al. Resilience in response to life stress: the effects of coping style and cognitive hardiness. Personality Individual Diff. 2003 Jan 1;34(1):77-95.

[4] Javanmard GH. Religious beliefs and resilience in academic students. Procedia-Social and Behavioral Sciences. 2013 Jul 9;84:744-8.

[5] Ong AD, et al. Psychological resilience, positive emotions, and successful adaptation to stress in later life. J Pers Soc Psychol. 2006 Oct;91(4):730-49.

[6] Ergün-Başak B, Can G. The relationships between self-compassion, social-connectedness, optimism and psychological resilience among low-income university students. Ilkogretim Online. 2018 Apr 1;17(2):768-85.

[7] Waugh CE, et al. Flexible emotional responsiveness in trait resilience. Emotion. 2011 Oct;11(5):1059.

[8] Bonanno GA, et al. What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. J Consult Clinical Psych. 2007 Oct;75(5):671.

[9] Fletcher D, Sarkar M. Psychological resilience: a review and critique of definitions, concepts, and theory. Eur Psychol. 2013;18(1):12.

[10] Mulholland DJ, et al. Academic performance in children of divorce: psychological resilience and vulnerability. Psychiatry. 1991 Aug;54(3):268-80.

[11] Lowe SR, et al. Psychological resilience after Hurricane Sandy: the influence of individual- and community-level factors on mental health after a large-scale natural disaster. PLoS One. 2015 May 11;10(5):e0125761.

[12] Hahn EA, et al. Time use and well-being in older widows: adaptation and resilience. J Women Aging. 2011;23(2):149-59.

[13] Greeff AP, Human B. Resilience in families in which a parent has died. Amer J Family Ther. 2004 Jan 1;32(1):27-42.

[14] Meredith LS, et al. Promoting psychological resilience in the US military. Rand Health Quarterly. 2011;1(2).

[15] Ghanei Gheshlagh R, et al. Resilience of patients with chronic physical diseases: a systematic review and meta-analysis. Iran Red Crescent Med J. 2016 Jun 28;18(7):e38562.

[16] Bonanno GA, et al. Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack. Psychol Sci. 2006 Mar;17(3):181-6.

[17] Bonanno GA, et al. Psychological resilience and dysfunction among hospitalized survivors of the SARS epidemic in Hong Kong: a latent class approach. Health Psychol. 2008 Sep;27(5):659-67.

[18] Nath P, Pradhan RK. Influence of positive affect on physical health and psychological well-being: examining the mediating role of psychological resilience. J Health Management. 2012 Jun;14(2):161-74.

[19] Cal SF, et al. Resilience in chronic diseases: a systematic review. Cogent Psychology. 2015 Dec 31;2(1):1024928.

[20] Yi JP, et al. The role of resilience on psychological adjustment and physical health in patients with diabetes. Br J Health Psychol. 2008 May;13(Pt 2):311-25.

[21] Ong AD, et al. Psychological resilience predicts decreases in pain catastrophizing through positive emotions. Psychol Aging. 2010 Sep;25(3):516.

[22] Sturgeon JA, Zautra AJ. Resilience: a new paradigm for adaptation to chronic pain. Curr Pain Headache Rep. 2010 Apr;14(2):105-12.

[23] Koch L, et al. Fear of recurrence and disease progression in long‐term (≥ 5 years) cancer survivors—a systematic review of quantitative studies. Psycho‐Oncology. 2013 Jan;22(1):1-1.

[24] DiLorenzo TA, et al. A model of disease-specific worry in heritable disease: the influence of family history, perceived risk and worry about other illnesses. J Behav Med. 2006 Feb;29(1):37-49

[25] Keil DC, et al. The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability. Chron Respir Dis. 2014 Feb;11(1):31-40.

[26] Räikkönen K, et al. Effects of optimism, pessimism, and trait anxiety on ambulatory blood pressure and mood during everyday life. J Pers Social Psych. 1999 Jan;76(1):104.

[27] Janssens T, et al. Dyspnea perception in COPD: association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program. Chest. 2011 Sep;140(3):618-25.

[28] Radek KA. Antimicrobial anxiety: the impact of stress on antimicrobial immunity. J Leukoc Biol. 2010 Aug;88(2):263-77.

[29] Janson C, et al. Anxiety and depression in relation to respiratory symptoms and asthma. Am J Respir Crit Care Med. 1994 Apr;149(4 Pt 1):930-4.

[30] Erdogan E, et al. University students’ resilience level: the effect of gender and faculty. Procedia-Social Behav Sci. 2015 May 13;186:1262-7.

[31] Hammer JH, Good GE. Positive psychology: an empirical examination of beneficial aspects of endorsement of masculine norms. Psychology of Men & Masculinity. 2010 Oct;11(4):303.

[32] Hirani S, et al. The intersection of gender and resilience. J Psych Mental Health Nursing. 2016 Aug;23(6-7):455–67.

[33] Ong AD, et al. Psychological resilience, positive emotions, and successful adaptation to stress in later life. J Pers Soc Psychol. 2006 Oct;91(4):730-49.

[34] Sirois FM, Wood AM. Gratitude uniquely predicts lower depression in chronic illness populations: A longitudinal study of inflammatory bowel disease and arthritis. Health Psychol. 2017 Feb;36(2):122-32.

[35] Huffman JC, et al. Effects of optimism and gratitude on physical activity, biomarkers, and readmissions after an acute coronary syndrome: the gratitude research in acute coronary events study. Circ Cardiovasc Qual Outcomes. 2016 Jan;9(1):55-63.[36] Rasmussen HN, et al. Optimism and physical health: a meta-analytic review. Ann Behav Med. 2009 Jun;37(3):239-56.

Written By:
Elisabeth Philipps

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