Dr Jacqueline Boyle, Consultant Clinical Psychologist & Dr Anita Wraith, Consultant Clinical Psychologist Clinical Health Psychology Services

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 Palace manager, Iain Dowie. (Wiktionary, accessed ) “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 Adapting under pressure Thriving despite or because of pressure Being strengthened or improved by adversity Positive emotions (buffer against depression) Emotional flexibility Positive response to change Ability to foster good relationships Control over own workflow Ability to establish a sense of community at work Source: Chichetti, 2010

Three Layers of Resilience: Individual coping skills Personal values – compassion, professionalism etc Feeling valued in your role with patients “Gallows humour” Individual Resilience Team relationships Social Support Mentoring / sharing ideas / supervision Interpersonal / Team Resilience Leadership (NHS Confederation, 2011b) Creating learning opportunities and development from mistakes Organisation Resilience 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?

Work-Life Balance Social Support – Friends, family & colleagues Spirituality Be decisive Acceptance Self soothing Realistic Goal Setting Hobbies & Interests Meaningful Activities Opportunities for learning after adversity Generate Helpful thoughts Relaxation Meditation Self Care: Sleep, Nutrition, Exercise

Resilience Skills Emotional resilience Resilient thinking Balance & recovery 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) ThoughtsFeelingsBehaviours Physical response(s) 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 ThoughtsFeelingsBehaviours Physical response(s)

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 Personnel Today [Online] resilience/ resilience/ Andrews, S. & Thorne, F. (2015) What do people need to be resilient in the current NHS? Clinical Psychology Forum, 276, 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),