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.