Dr Jacqueline Boyle, Consultant Clinical Psychologist & Dr Anita Wraith, Consultant Clinical Psychologist Clinical Health Psychology Services jacqueline.boyle@midyorks.nhs.uk anita.wraith@midyorks.nhs.uk How to Survive in the NHS if You Aren’t Bear Grylls: Some Ideas on Building Resilience What is resilience? Some definitions … • Bounce-back-ability - the ability to recover from bad circumstance. First claimed [to have been invented] by Crystal (Wiktionary, accessed 16.5.16) Palace manager, Iain Dowie. • “The greatest glory of living, lies not in never falling, but in rising every time you fall.” (Nelson Mandela) • “It’s not the strongest of the species that survive, nor the most intelligent, but the most responsive to change.” (Charles Darwin) • “What doesn’t kill me, makes me stronger” (Nietzsche) What is resilience? Bouncing back Ability to establish a sense of community at work Adapting under pressure Control over own workflow Thriving despite or because of pressure Ability to foster good relationships Being strengthened or improved by adversity Positive emotions (buffer against depression) Positive response to change Emotional flexibility Source: Chichetti, 2010 Three Layers of Resilience: Individual Resilience • • • • Individual coping skills Personal values – compassion, professionalism etc Feeling valued in your role with patients “Gallows humour” Interpersonal / Team Resilience • Team relationships • Social Support • Mentoring / sharing ideas / supervision Organisation Resilience • Leadership (NHS Confederation, 2011b) • Creating learning opportunities and development from mistakes Andrews & Thorne (2015) Sharing Resilience… Exercise … • Think of two people you know who are very resilient and one who is not • What do the two have in common that makes them different from the third in this respect? Exercise 2 … • What do you do, or what do you suggest that others should do, to help build resilience? Self Care: Sleep, Nutrition, Exercise Spirituality Work-Life Balance Generate Helpful thoughts Meaningful Activities Opportunities for learning after adversity Social Support – Friends, family & colleagues Hobbies & Interests Acceptance Be decisive Self soothing Realistic Goal Setting Relaxation Meditation Resilience Skills Balance & recovery Emotional resilience Resilient thinking Flexible thinking Optimism Why zebras don’t get ulcers • Zebras don’t respond to thoughts of lions, they respond only to real lions • Humans respond to thoughts of lions • Humans experience stress response in relation to thoughts as well as real experiences of threat The importance of thinking (Cognitive-Behavioural Model) Thoughts Physical response(s) Feelings Behaviours Source: Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press Developing resilience THINKING – ATTITUDES We can’t always control what happens to us but we can control how we think and respond Attitudes towards new challenges Face up to, overcome the event • And ultimately benefit Face up to but do nothing about the event • & still benefit We can do nothing about the event as it’s too big for us to deal with (withdraw until the event has passed vs. ‘act out’) • Flight or fight response • Correlated with distress/stress It is not just “think positive”; it’s about recognizing our responses & developing “flexible thinking” Flexible thinking 1. Testing negative thoughts & predictions 2. Analysing our thoughts (thinking errors) Testing negative thoughts & predictions Thoughts Physical response(s) Feelings Behaviours Exercise: Testing negative thoughts & predictions • Ask yourself the following Q’s – Is [thought] true, in fact? – What is the worst that can happen? – What does this say about me? – What does this say other people think of me? These Q’s help us get to the bottom of what we find threatening in a situation Thinking Errors • Are these thoughts helpful or useful? • Are they true? • Are they helping me stay resilient? • Are they making me more stressed? A little story…. Balancing our thinking Where is the evidence? What are the exceptions? What is the whole picture? How would someone else [respected other] see this? What would they say? Identifying the initial (unhelpful) thought – put on the brakes Summary • Resilience: – Is a psychological strength – It can help us adapt & grow from challenges – It is NOT a fixed state – Can be developed & enhanced in all 3 layers (individual, team & organisation) – Practical strategies and flexible thinking can be helpful – Important to hold onto “multiple truths” References & Further Reading • • • • • • • • Nietzsche F (1888). Twilight of the Idols. Chichetti, D. (2010). Resilience under conditions of extreme stress: A multilevel perspective. World Psychiatry, 9(3), 145 – 154. Neenan M (2010). “Developing resilience: a cognitive behavioural approach”. Routledge. Mowbray, D. (2010, 2014). Strengthening Personal Resilience. Management Advisory Service. [Online] Harrington, A. 2012. Personnel Today [Online] http://www.personneltoday.com/hr/understanding-the-importance-ofresilience/ Andrews, S. & Thorne, F. (2015) What do people need to be resilient in the current NHS? Clinical Psychology Forum, 276, 12-15. NHS England. (2014). The 2013 NHS staff survey in England. Redditch, Worcestershire: Author. Lee, A.V., Vargo, J. & Seville, E. (2013). Developing a tool to measure and compare organisations resilience. Natural Hazards Review, 14(1), 29-41.