Can You Teach Resilience?

See replies by Peccoralo et al and Sim and Chew, brief report by Pietrzak et al, and article by Chew et al

J Clin Psychiatry 2021;82(5):21lr14035

To cite: Modesto-Lowe V, LaBell JC, Meyers NZ. Can you teach resilience? J Clin Psychiatry. 2021;82(5):21lr14035.
To share: https://doi.org/10.4088/JCP.21lr14035

© Copyright 2021 Physicians Postgraduate Press, Inc.

^aConnecticut Valley Hospital, Middletown, Connecticut
^bQuinnipiac University, Hamden, Connecticut
^cUniversity of Connecticut School of Medicine, Farmington, Connecticut
^dQuinnipiac University School of Health Science, Hamden, Connecticut
*Corresponding author: Vania Modesto-Lowe, MD, MPH, Connecticut Valley Hospital, Addiction Services Division, PO Box 351, Middletown, CT 06457 (vania.modesto-lowe@ct.gov).

To the Editor: Cross-national data indicate high levels of anxiety, depression, and insomnia among frontline health care workers (FHCWs) attending to coronavirus disease 2019 (COVID-19) patients.^1,2 Shechter et al¹ found that 57% of FHCWs experienced acute stress, 48% reported depressive symptoms, and another 33% expressed symptoms of anxiety. The study concluded that midlevel providers, as well as nurses, experienced the highest level of COVID-19–related psychological distress and theorized that this may be due to a more direct involvement in patient care.¹ Another study, by Chew et al,³ found that FHCWs also experienced loss, grief, and guilt as a result of losing both colleagues and patients.

While the attention of researchers has focused primarily on the adverse psychological effects experienced by FHCWs, little is known about fostering resilience in this population. Recent efforts to address this gap include a study by Pietrzak et al,⁴ who explored the factors related to resilience in a survey of 6,026 FHCWs during the peak of the pandemic in New York. The study showed that resilience correlates strongly with self-efficacy, positive emotions, purpose in life, social support, and refraining from substance use as a coping mechanism.⁴ Regardless, merely identifying these personal and environmental factors is not enough to assist FHCWs in managing their stressors in a “resilient fashion.”

Although resilience remains difficult to conceptualize, most constructs imply that it involves positive adaptations to adversity.⁵ Early descriptions depict resilience solely as an innate personality trait. Recent theories, however, view resilience as a multifactorial, dynamic process that is amenable to change.⁵ In this context, it is important to not only identify social, cognitive, and coping factors, but also design measurable and achievable interventions to strengthen resilience. Toward this end, Winwood et al⁶ developed the resilience at work (RAW) scale, which consists of items such as mindfulness, belonging, positivity, balance, physical fitness, and social support that can be harnessed to foster resilience at work. While efforts to validate this scale are ongoing, research also needs to focus on resources that can cultivate resilience among FHCWs.⁷ “Battle Buddies,” a program originally developed by the US Army, illustrates how health care systems can encourage social connectedness among FHCWs during the COVID-19 pandemic.⁷ Preliminary data suggest its effectiveness in reducing COVID-19–related psychological symptoms among FHCWs.

Unfortunately, there remains no evidence-based set of recommendations designed to improve resilience among FHCWs. Nevertheless, coping style, organizational support, and sense of self-efficacy all seem to influence whether FHCWs exhibit psychological harm or instead demonstrate resilience. Furthermore, adding a research piece to existing programs can improve understanding of how to harness resilience in FHCWs during recurrent waves of COVID-19.

Published online: July 27, 2021.
Potential conflicts of interest: None.
Funding/support: None.