Build Resilience and Cope with Stress

Introduction

We all encounter stressful situations and events: death of a loved one, pressure at work or at school, serious illness or accidents, assaults, or any number of other traumatic events. While we all experience these difficult periods of life (sometimes very difficult), we generally find a way to get through them due to our resilience, which we can define simply as the ability to cope and to bounce back from stress and problems. The way that victims, spectators, care-givers, and resident responded to the Boston Marathon bombing is a high profile example of great resilience. We all experience stresses and trauma that can affect us individually and bring us to periods of worry, stress, and psychological pain. Getting beyond these problems involves resilience. Resilience does not mean avoided stress and adversity; it means have the ability to persevere and continue to function effectively despite failures, setbacks, and losses. This requires developing effective coping skills. People who are able to persist and continue to function at a high level in times of adversity generally have greater self-efficacy and less fear of failing.

Some people are more resilient than others, but resilience is not an innate trait that one is born with. It is a response that can be learned and nurtured, and there are some simple things that we can do to build our personal resilience. This brief module provides some insights and some evidence-based tips on how to build and nurture your resilience. These will not provide a way of avoiding the stresses and travails that are thrown in our path, but they will help you build the resilience to work through them to the other side.

This page is adapted from the module entitled "Dealing with Stress in Disasters" at the Local Public Health Institute of Massachusetts. (Link to the LPHI module)

What is Stress?

This page is copied from the Local Public Health Institute of Massachusetts module at the following link: Link to Building Psychological Resilience for Dealing with Disasters.

Merriam-Webster Dictionary defines stress as: "a physical, chemical, or emotional factor that causes bodily or mental tension, and may be a factor in disease causation." If you were to ask people to explain what stress is and how it affects them, you would likely get a wide variety of definitions. Many factors and situations have the potential to impact us in stressful ways, but it is important to note our individual perceptions and responses to these stimuli.

Athletes and performers often describe mental tension that arises prior to a contest or a performance, as anxiety or outright fear. Nevertheless, they acknowledge that this tension can both overwhelm the individual and result in a disastrous performance, or it can be the source of a positive response that brings out the very best in people. The graphic below attempts to illustrate both the potentially motivating effects of stress and the adverse effects of excessive or prolonged stress combined with poor coping skills (on the right).

Although we frequently have little control over stressful factors and situations, it is possible to train yourself to modulate your thoughts, emotions, and your environment in ways that help you to deal with the problems you encounter, rather than allowing events take control of you. Conceptually, your efforts to develop psychological resilience can expand your range of good stress and shrink the range of debilitating stress. This is what is meant by building psychological resilience, and it is particularly important for public health workers and emergency responders.

The Stress Reaction

French physiologist Claude Bernard was the first to introduce the concept of dynamic equilibrium, or steady state. Organisms, even individual cells within organisms, are subject to never-ending changes in conditions. But in order to survive and maintain optimal function, built-in mechanisms respond to altered conditions (stresses) by making adjustments that are designed to re-establish equilibrium. As a simple example, if the external temperature rises, our bodies automatically perspire - a compensatory response that reduces our internal temperature.

Neurologist Walter Cannon applied the term homeostasis to this concept of dynamic equilibrium. Cannon was the first to propose that stressors could be emotional as well as physical, and he described the "fight or flight" response that occurs when animals are threatened with immediate danger (a severe stress). Hans Selye, another scientist, extended Cannon's observation and discovered that the "fight or flight" response is mediated by the secretion of powerful neurotransmitters. Stimuli from the brain also cause the hypothalamus to release corticotrophin releasing factor (CRF). CRF then causes the secretion of adrenocorticophic hormone (ACTH) from the pituitary gland at the base of the skull. ACTH travels to the adrenal glands via the blood stream and stimulate the release of cortisol, epinephrine, and norepinephrine. These neural and hormonal mechanisms mediate our responses to both ordinary stresses and intense stress.

Types of Stress

• Normal Stress (Eustress) - An occurrence that causes a minimal amount of stress which passes quickly. It might provide a burst of energy that helps you get things done or a stimulus that helps you focus and improves your performance.  Example: Athletes who are nervous before a competition can use their stress to sharpen their focus, enhance their alertness, and improve their performance.
• Distress - A more severe stress that causes significant disruption, but occurs for a relatively short period. The effects are significant, but temporary, and the individual typically returns to a normal state.. Example: A car crash in which the passenger suffers minor injuries.
• Traumatic Stress - The result of a profound event that alters one's beliefs and assumptions. Affected individuals recover over time, but they are forever changed. Stresses that are profound or unrelenting may exceed our capacity to cope, eventually causing fatigue, exhaustion, or breakdown. Example: A natural disaster or a major health diagnosis to oneself or a loved one.

One can also categorize stress based on its chronicity (from American Psychological Association: The Different Kinds of Stress). 

Chronicity of Stress

• Acute Stress - The most common form of stress. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future. Acute stress is thrilling and exciting in small doses, but too much is exhausting. Example: A fast run down a challenging ski slope is exhilarating in the morning, but can become taxing and wearying later on in the day. Skiing beyond your limits can lead to falls and broken bones.
• Episodic Acute Stress - There are those, however, who suffer acute stress frequently, whose lives tend to be infused with chaos and crisis. They have many simultaneous demands of their time and attention and their inability to organize them leads to episodic acute stress. It is common for people with acute stress reactions to be over aroused, short-tempered, irritable, anxious, and tense. Often, they describe themselves as having a lot of nervous energy. They tend to always be in a rush, yet are always late. They tend to be abrupt and irritable. Interpersonal relationships deteriorate oftentimes because others tend to respond with hostility.  Example: Those described as "Type As" and 'worry warts' have characteristics that can create frequent episodes of acute stress.
• Chronic Stress - The grinding stress that wears people down a little at a time over a long period of time. Chronic stress comes when a person cannot see a way out of a miserable situation. It can be unrelenting demands and pressures for seemingly interminable periods of time. Losing hope, the individual gives up searching for solutions. Some chronic stresses stem from traumatic, early childhood experiences that become internalized and remain painful and present. A view of the world or a belief system is created that perpetuates the unending stress (i.e., the world is a threatening place, you must be perfect at all times). The worst aspect of chronic stress is that people often get used to it. They may forget it is there. People are immediately aware of acute stress because it is new, yet they can ignore chronic stress because it is old, familiar, and sometimes, almost comfortable. Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management. Example: The stress of poverty, being in a dysfunctional family situation, being trapped in a despised job or career.

Coping Strategies and Techniques

Maintain Your General Health

Taking care of your body is an important first step toward mental and emotional health. Below is a list of ways to improve your physical health: 

• Get enough rest
• Practice good nutrition
• Stay hydrated
• Exercise
• Get a dose of sunlight every day

Engage in Regular Physical Activity

Many activities have been shown to reduce stress whether it involves team sports, group activities, or individual activity. Find a way to squeeze some regular activity into your day. Consider:

• Jogging
• Hiking
• Walking
• Biking
• Gardening
• Dancing
• Yoga
• Tai chi
• Stretching

Engage in Regular Mental Activities That Reduce Stress

• Take a break and do something that is fun and creative - write, draw, paint, doodle
• Practice conscious relaxation. Lie or sit in a comfortable place, close your eyes, and concentrate on letting all of your muscles go limp. Focus your mind on a pleasant, peaceful place
• Practice mindfulness - Focus on the positive aspects of your environment. Actively look for beauty and complexity; focus on specific things to fully appreciate their detail and intricacy. Reflect on your day. Neuroscientists have found that training people in mindfulness actually changes the brain, as demonstrated with imaging techniques, to make it more similar to that of resilient people.
• Try guided imagery, a program of directed thoughts and suggestions that guide your imagination toward a relaxed, focused state. For example, imagine an orange in great detail - how it smells, its color, the texture of its peel, etc. See yourself taking a bite of the orange and imagine the juice squirting into your mouth. There are tapes and scripts that can help you with this method.
• Meditate
• Read a novel
• Play a musical instrument
• Practice deep abdominal breathing
• Try using Chinese tranquility balls (Link to more on tranquility balls)
• "Finger walk" through a Cretan labyrinth like the one shown below. Trace the path with your finger. Create your own labyrinth.

More Advice on Reducing Stress

Maintain and Connect with Your Social Support Network

A personal support network is essential for building and maintaining your resilience. You need to build and maintain relationships with family members, friends, peers, and co-workers. Encouragement and support from these relationships is extremely effective in helping you work through stressful periods. Your peers can be a vitally important component of your support network, because they are likely to be experiencing similar stresses. Consequently, they are able to validate your feeling, empathize, and perhaps provide good advice as to how to deal with specific problems and situations.

Peer Support Groups

You might consider establishing your own peer support groups in a way that is best suited to the time and space limitations of you and your peers.

The following information on Peer Support and Education is adapted from http://www.newhealthpartnerships.org

Today there are support groups for any number of things: caregivers, dieting, exercise, grief, illnesses, mental health, etc. What these groups have in common is that they consist of people who share a common experience. Peer support can be informal or more organized with regular meetings. The key thing is for the support group to focus on listening to and supporting one another and sharing information and advice.

Peer support helps in at least four ways.

1. Emotional support
2. Practical advice
3. Practical help - like an exercise partner or a ride to the doctor
4. Increased confidence from seeing others like you succeed at self-care

And it is a two-way street, meaning that you provide support, advice, and information as well as receiving it. You can provide peer support as well as receive it.

The key skills to providing peer support are:

• Listening is often the best help we can give.
• Sharing your knowledge, your techniques for emotional resilience and coping techniques; telling others how you got through similar problems will give them hope and ideas.
• Giving advice, although this should usually be kept to a minimum. What worked for you might not work for them. But you can present ideas for them to check out.
• Sharing information. Group members may know of books, web sites, articles, or other resources that may be helpful. Or peers may be able to suggest specific people or agencies that may be useful in solving problems or reducing stress.
• Working together to provide mutual support

When to Get Professional Help

Certain feelings and behaviors signs indicating the need for prompt professional help. Important warning signs are:

• Inability to sleep.
• Feeling down, depressed, hopeless, or helpless most of the time.
• Difficulty concentrating to the extent that it interferes with your studies, work, or home life.
• Using smoking, overeating, drugs, or alcohol to cope with difficult emotions.
• Negative or self-destructive thoughts or fears that you can't control.
• Thoughts of death or suicide.

If you feel that your resilience is crumbling, you should seek help without delay. And if you are unsure about what to do or where to seek help, you should contact the staff in Student Services, since they can connect you with appropriate professional help.

Resources

1. The road to resilience - American Psychological Association
2. "Bounce Back" by Mandy Oaklander. TIme Magazine, Frontiers of Medicine, June 1, 2015