Four tips for building psychological resilience

Life is often stressful. These stresses can come in all shapes and sizes, from the burden of financial debt to the hassle of a fender-bender; from the heartache of a sick parent to the irritation of a late train. The bottom line is that whatever form it comes in, we can’t avoid stress. So what can we do about it? One obvious suggestion is to reduce the amount we’re exposed to: pay that bill a.s.a.p. and be careful to avoid other cars when parking in multi-storey car parks. This is good advice, but the reality is that not all stress can be avoided. For these types of stresses, it can help to increase our capacity to cope: our ‘psychological resilience’. But how can we do this? Here, I offer four tips based on research I have conducted into the factors that confer resilience.

1. Know your strengths: build your confidence. My research has shown that having high self-esteem helps people be resilient to stressful events. In a previous blog post, I outline one evidence-based technique for building self-esteem. Briefly, this works by encouraging you to consider your personal ‘strengths’ and then getting you to think of specific pieces of evidence which show that you have this strength. For example, if your strength is that you’re a good listener, a piece of evidence might be that a friend from work confided to you about their recent break-up last week. 

First though, you have to be willing to allow yourself to do this. When I deliver resilience training, many people I speak with are embarrassed to acknowledge the things they’re good at, for fear of appearing egotistical or narcissistic. This belief is both misleading and detrimental, as some individuals who are highly narcissistic in fact report low levels of underlying self-esteem. The reality is that knowing your strengths can help you to build a quiet confidence that will improve the way you work, and will not make you appear egotistical.

resilience

2. Learn to let yourself off the hook. Being a perfectionist is one of the worst things you can do for your mental health. It’s linked with higher levels of depression, anxiety and self-harm and it’s terrible for psychological resilience. What this tells us is that reducing our perfectionism could boost our psychological wellbeing and levels of resilience. There are misconceptions around perfectionism though, with people sometimes fearing that being less perfectionistic could make them less effective or high achieving. This isn’t the case. Perfectionism is about rigidity: it’s when people push themselves hard, no matter what. Being less perfectionistic involves self-awareness. It’s about knowing when to strive and push forward, and when to let yourself off the hook. If you’re a fitness enthusiast, this might involve knowing when it’s time to take a couple of days off training. If you’re a dedicated student, it might be knowing when it’s time take the afternoon off revision to see friends. For detailed suggestions on tackling perfectionism, see my previous blog post.

3. Focus on the future. When the present is no fun, it’s important to have things to look forward to, and research shows that having hope for the future can help us be more resilient. These don’t have to be big things, but they need to be clear in your mind. For example, you might enjoy going for a coffee and reading the paper, going for a walk in a park, or reading books. This practice is often incorporated into cognitive-behaviour therapy (CBT), and is called ‘pleasant event scheduling’. A recent study which tested the impact of pleasant event scheduling when done in isolation, without any of the other aspects of CBT, found it was effective in reducing risk of depressed mood. It’s not rocket science though – you can easily do this yourself by making a list of things you’d like to do and then scheduling these in your diary.

resilience

4. Don’t beat yourself up when things go wrong. There are three main ways that we explain negative events in our lives. First is how much we blame ourselves, compared with other people or the situation. Second is how permanent our explanations are: whether the problem that caused this one event is likely to keep on causing negative events in our future. Third is how all-encompassing are explanations are: whether this cause is going to make trouble in other areas of our life, as well. For example, if we were to fail an exam, we could think, “This is all down to my own general stupidity. I knew I’d never get through it”. This explanation is negative as we’re taking the blame entirely on ourselves. We’re also doing it in a permanent, all-encompassing way: if we’re stupid, it’s probably going to affect everything we do, forever.

The way we tend to explain events is habitual and it’s called ‘attributional style’. Resilient people explain events in a way that is more positive. In an exam failure situation, a resilient person would acknowledge any stress they’re under, or any other factors that could have affected their performance. Furthermore, they’ll do this in a way that doesn’t leak into other areas of their life and gives them hope for the future. In this example, a resilient person might think, “It was a stressful time with my mum being ill. I haven’t had to manage this kind of situation before, and the result was that I didn’t allow enough time to revise. I’ve learned for the future though: I know what I’ll do differently next time”. Not only will this person feel less bad about the exam failure, they’re also more likely to pass next time. It’s possible to change the way that you explain events with cognitive-behaviour therapy. For a do-it-yourself approach to improving your attributional style, I’d encourage you to ask yourself three questions when you know you’re beating yourself up about something:

  1. What range of factors contributed to this event? When things go wrong, they can rarely be pinned on just one thing. List all the things you know contributed to the event, to help yourself create a balanced perspective.
  2. What else has gone right recently? Think about other things that went to plan, no matter how small. This might be, for example, a friend’s birthday that you remembered, a work task that you completed well or a tricky conversation that you handled sensitively. It’s important to remember that this negative event doesn’t define you.
  3. What can you do to reduce the chance that a similar event will occur in future? Think about anything you’ve learned from this. Think about any actions you can take, whether this is personal (e.g., allowing more revision time in future) or external (e.g., asking for input from a tutor).

With all of these tips, it’s important to know that having good relationships with friends or family can help. Talking to others about stress you’re experiencing can help you to realise when it’s time to take action and can help you to change your perspective. Have you ever moaned to a friend about a rough day at work, and appreciated it when they pointed out that it wasn’t all your fault? Well, that’s an example of them helping you to develop a more positive attributional style for that event. The take home message is: talk about it! It’s easier than trying to do it alone.

This article was originally posted on the Psychreg website on 14 June 2019.

Breaking bad news in healthcare: why we shoot the messenger

Breaking bad news is a cornerstone of healthcare delivery. From the doctor delivering blood test results in cancer services to the sonographer communicating the discovery of a pregnancy loss, healthcare professionals regularly find themselves in this challenging situation.

But why is it so challenging? In theory, the healthcare professional is simply the messenger: the person relaying information about an event they did not cause and had no influence over. The reality is nothing like this, though. Research tells us that healthcare professionals find these situations highly stressful, particularly when the news is unexpected or seems unusual or unjust. Some end up coping in unhelpful ways; distancing themselves from the patient by using technical language, delaying the communication of the news or avoiding it altogether and passing the task on to someone else. These coping tactics often backfire by creating a more negative experience for the patient and further increasing the stress the healthcare professional feels.

breaking bad news

A recent study has shed light on these conversations, identifying some of the underlying reasons for why these events are quite so difficult for healthcare professionals. This study conducted a series of 11 experiments, which together showed that:

  • After receiving bad news, people feel a need to try and ‘make sense’ of it
  • To help them ‘make sense’ of bad news, people dislike the person who told them, even if they clearly are not to blame for what has happened
  • People dislike the messenger even more if the news is unexpected, or if it is particularly unjust or unusual
  • The reason that people dislike those who tell them bad news is because they think these messengers have bad motives: they mean badly
  • This effect is reduced if recipients of bad news have reason to think the messenger has benevolent motives or means well

This study used a range of news delivery scenarios, including one where a person was told that they had not won a $2 bonus and another where their scheduled flight was running late. However, I think this study has important implications for healthcare settings for three main reasons:

  1. It brings a new perspective to why these events are so challenging for healthcare professionals. It’s not logical, but the truth is that patients will like professionals less when they deliver bad news, and consciously or subconsciously, professionals know this. Building good professional-patient relationships is a key part of healthcare delivery, and having to deliver bad news works against this.
  2. It highlights the situations where delivering bad and difficult news is going to be most challenging. Specifically, these are likely to be where the news is unexpected or where it is particularly unusual or unjust. I think that two key settings where staff should be better supported with this task are obstetric ultrasound and maternity services more broadly, as the news is often unexpected and paediatrics, where bad news could be more likely to be perceived as unusual and unjust. In these situations, the recipients of bad news may have to work harder to make sense of the information they have received, and as such, may be more likely to ‘shoot the messenger’.
  3. It offers a suggestion for how healthcare professionals can reduce the ‘shoot the messenger’ effect: namely, by communicating their benevolent intentions. For example, this could involve saying ‘I’m so sorry, I hoped to bring you better news than this. This must be so difficult for you to hear’. However, doing this requires professionals to be forthcoming and open. Unhelpfully, the impact of stress often has the opposite effect: it inhibits people, making them more careful and wary of saying ‘the wrong thing’; therefore increasing the chance that they’ll say very little. What this research shows is that by going against the natural instinct to say little in stressful situations, healthcare professionals can reduce the ‘shoot the messenger’ effect and help create a better experience for both themselves and their patients. It is also consistent with findings of a review I conducted which showed that training healthcare professionals in breaking bad news works: it enhances their confidence of how to manage these difficult situations and improves their skills.