Personal levels of resilience may help to determine how well, or not, an individual copes with the mental and emotional difficulties associated with Covid-19. In the first of three articles, Catherine D’Arcy-Jones outlines how occupational health practitioners can better understand the psychological basis of resilience and some of the tools available to measure it.
Many of us within our normal occupational health (OH) remit will be supporting employees to access their inner resilience skills and build up techniques they can use in a variety of situations. Certainly, the current coronavirus situation has highlighted the nation’s resilience, or the need to increase it, and the importance of having an effective bag of resilience skills to draw upon.
Life presents many varied situations and how these are interpreted, and reacted to, will contribute to the eventual outcome. Each and every person has skills that allow them to adapt, change, learn and cope. We just need to be able to recognise these, know how to access them, be open to learning new skills and apply them.
About the author
Catherine D’Arcy-Jones SCPHN, RGN, BSc Psychology, MSc Health Psychology, BSc Occ Health is director of occupational health company OPA Health
This article, the first of a series of three, is aimed at enhancing an understanding of the psychological basis of resilience and some of the tools available to measure it. There is a plethora of scales to choose from, each measuring varying aspects of resilience. Once we are knowledgeable about the different areas of resilience, individuals have a greater potential to control them (Johnston-Wilder S 2018).
For OH practitioners guiding individuals, understanding the areas of low resilience brings a greater awareness of where recommendations and focus needs to be directed to redress any individual inbalance and increase an employee’s personal resilience. Developing resilience is an ongoing cycle (Chowdhury 2020) and we continually learn and adapt as we gain experience from situations we are presented with.
Resilience is within us all. Originating from the 1620s, the word “resilience” was derived from the Latin “resiliens” meaning to recoil or rebound. In the 1640s, the word was associated with “springing back” and was finally incorporated into the English language in the mid-17th century. The area of resilience is not new, however; it has developed in its understanding over many years of research, application of theory and revision of different techniques.
Psychological basis of resilience
The impact of personality and hardiness on both physical and mental health has been more widely understood since the original work of Kobasa (1979). Kobasa saw hardiness as an influencing factor in an individual’s resistance to stress linking cognitive, behavioural and emotional elements.
This builds on the psychological concept of locus of control, introduced by Julian Rotter in 1966 and later developed by Bandura in 2006. This linked the view that an individual’s attitudes and beliefs associated with the environment they are in affects their behaviour and the consequent actions taken in the situation.
Locus of control falls into two categories. First there is internal, or believing that the outcome of events is caused by controllable factors influenced by individual abilities such as attitude, effort and reactions to experiences causing either success or failure. The opposite is true of an external locus of control, where belief lies that the individual is not in control of their life and success or failure is attributed to fate, chance or the power of others.
The current coronavirus situation has highlighted the nation’s resilience, or the need to increase it, and the importance of having an effective bag of resilience skills to draw upon
Rotter cites the importance of the protective aspects of an internal locus of control, whereby personal control can influence the way events are interpreted, as opposed to an external locus of control. He links those with a higher internal locus of control as manifesting more stress resistance and those with a higher external locus of control experiencing more anxiety related symptoms.
We can see an example of the impact of this now during the current coronavirus pandemic and the varying individual responses to the government-imposed lockdown process. Those who concentrate on factors they can influence to some degree, such as diet, exercise, sleep and maintaining communication, are more likely to demonstrate higher resilience than those who concentrate solely on external factors outside of control, such as statistics of morbidity, mortality and 24-hour news.
However, maintaining a positive outlook is made more challenging when individuals can relate to others in the news where bereavement or negative health effects are being presented regularly. There is increased time to reflect, personalise and subsequently relate to the impact of heart wrenching individual stories, forming associations between people, even when they have not met, based on a collective feeling of fear and common concern.
Having the psychological strength to maintain our own mental wellness, and support the mental health of others, in these circumstances becomes more difficult. A further factor to consider is the constant psychological readjustment individuals are making to changeable timelines of government restrictions and guidelines, highlighting the impact and influence of external events.
An understanding of the interplay of factors with the potential to impact on an individual’s resilience in this period – especially during the weeks of lockdown – is relevant to occupational health practice, and is of particularly relevant during the current Covid-19 pandemic.
The impact of this on the nation’s mental health is having both immediate and likely, as yet unknown, long-term effects. Those with high levels of personal resilience will find it easier to cope with the difficulties associated with Covid-19. Conversely, those having low levels of personal resilience are likely to experience poor mental health over a protracted period and OH professionals must be mindful of this in relation to dealing with the effects of this pandemic.
Interpreting resilience within a psychological model
There have been various models of resilience. Seligman (2011) built upon an original model from Albert Ellis’s 1956 seminal ABC model, which outlines that emotional consequences (C) stem not directly from adversity (A) but from one’s beliefs about adversity (B). Seligman added to this model, stating that the key for the individual is to learn how to quickly and effectively dispel unrealistic beliefs about adversity (D) and to cope with the common thinking traps of over generalisation or judgement forming.
The impact of unhelpful thinking patterns, as identified within cognitive behaviour therapy, such as a catastrophe style thinking can be minimised if a variety of evaluations and outcomes of a situation are made and considered.
Seligman included the basis of this to extend his model further by including the importance of choosing new and more effective courses of action (E for “energisation”) in his later papers. He maintained that a higher level of cognitive fitness allows an increased ability to effectively solve problems, make improved decisions, deal with stress and change, to see alternate perspectives and be open to new ideas.
Certainly, in the current situation the world finds itself in, these past theories can be easily applied. Research since the original papers has gone onto confirm the importance of good stress resilience and the documented evidence in psychological research is vast.
What resilience tools are available?
We all juggle different areas of our lives and their various demands upon us on a daily basis. For many of us, the relationships between our physical health, mental health, work life, domestic situation and support from friends are finely balanced.
However, when one area becomes more prevalent or requires more of our focus, it is important to be cognisant of what happens to the other areas? How difficult is it to keep all areas functioning effectively but concentrating on where our needs are pulled to the most?
One area to assist in identifying where our main resilience lies, is the use of a resilience scale. A recent review by Ackerman in April 2020 looked at the most popular and empirically based resilience scales, including reviewing the differing elements and features of each.
Resilience scales tend to have much in common and are structured around four main concepts: vision (concepts of self-efficacy and goal setting); composure (emotional regulation and the ability to recognise, to understand and act on internal prompts and physical signs); tenacity (the concept of perseverance and hardiness); and reasoning (including problem solving, resourcefulness and growth through adversity). Here is a quick guide to the most commonly used scales:
1. The Connor-Davidson Resilience Scale. This tool, originally developed by two American psychiatrists, incorporates a 25-item self-administered scale. It measures a number of resilience factors, including the ability to adapt to change, to deal with new challenges, cope with stress, remain focused, not to become discouraged when faced with failure, and the ability to handle unpleasant feelings.
Since its conception, there have been variations presented, with varying numbers of items for the person to answer. However, analysis by Gonzalez et al in 2015 showed the greatest reliability and validity for the adapted 10-item scale. It is considered the resilience measure with one of the highest reliability scoring scales (Windle at al 2011) and is one of the most extensively used measures.
2. The Resilience Scale for Adults (RSA). Developed by Norwegian psychologists Friborg et al (2003), this scale is mainly for use within the clinical and health psychology fields.
The basis of the scale uses key determinants of individual psychological attributes, levels of family support and cohesion, and external support. Friborg believes the presence of these significantly determine how individuals adjust to long term stressors.
Further research by Friborg in 2005, linked a person’s personality traits as important influencing factors in resilience but no connection with cognitive ability was proved.
3. The Brief Resilience Scale (BRS). This scale is based on the premise of measuring an individual’s ability to “bounce back” from a stressor rather than the presence of factors associated having good resilience.
It also provides information about how individuals cope with health-related stressors. This makes this resilience scale different from the first two scales. Measuring how quickly an individual can adapt to perceived stressors, put in measures to address adversity and to consequently resist illness is advantageous for OH practitioners, as it gives insight into the areas of proactive advice that would help the individual cope with health related stressors (Smith et al 2008)
4. The Resilience Scale. Abiola and Udofia (2011) have evaluated the resilience scale developed by Wagnild and Young in 1993, which they consider has good reliability and validity.
This scale is useful when assessing the health influences on individual resilience. This scale incorporates a set of five core principles: a sense of meaningfulness or purpose; degree of perseverance; amount of individual self-reliance; equanimity (calmness and composure in a difficult situation) and existential aloneness (being alone with your unique feelings and thoughts).
5. The Scale of Protective Factors (SPF). This scale concentrates on measuring the influence of social relationships, planning behaviours and confidence on an individual’s psychological resilience in teenage years and adulthood.
It is a further scale concentrating on the protective factors associated with resilience. It was originally developed by Ponce-Garcia at el (2015) in an attempt to capture multiple aspects of resilience. Their research confirmed that it was the only scale to measure the impact of social and cognitive aspects of resilience.
The scale measures the comfort levels of social interactions rather than how many friends the individual may have. It also measures an individual’s confidence in reaching goals that have been set rather than the number of tasks or goals a person has.
6. The Predictive 6-Factor Resilience Scale. This scale combines a neuro-biological approach looking at the influence of health hygiene factors on psychological resilience.
Most other scales only focus on resilience from a mental health perspective, however Rossouw and Rossouw (2016) incorporated three areas of health hygiene in their measure: exercise, nutrition, and sleep hygiene.
Their research showed that resilience also relies on engagement in and maintenance of these health hygiene factors and that measuring aspects of resilience is wider than originally thought.
Looking at the definitions, the scales and psychological concepts behind resilience, it can be seen that resilience is a dynamic evolving process. It involves differing influences, reactions and negotiations across varying contexts and environments at both individual and organisational level.
Tools can be useful to use to aid tailoring advice, recommendations and when forming a clinical opinion. However, understanding the differing aspects and biases that each scale is based on is important to allow the practitioner to choose the scale that will suit both the circumstances and individual.
The challenge for occupational health practitioners is understanding which factors are having the biggest influence on the employee and which areas of resilience need addressing and building up. Use of resilience scales have a place in assisting this process and certainly the self-assessment element of these can act in a reflective capacity for the individual.
Within the next two articles, I will be taking you through the various aspects of these topics giving you a better understanding of the considerations required by the OH nurse or practitioner.
The next article in this series will aim to build upon the foundations of psychological theory and resilience, in particular exploring the influencing factors of both the individual and organisational resilience and its impact within the workplace.
The final article in the series will take a proactive view of resilience, focusing on health hygiene areas that OH practitioners can explore with their clients to increase an individual’s proactive engagement with resilience.
Abiola T and Udofia O (2011). “Psychometric assessment of the Wagnild and Young’s Resilience Scale in Kano, Nigeria”. BMC Research Notes 4, pp.509-513.
Ackerman C (2020). “How to measure resilience with these eight resilience scales”, Positive Psychology, available online at https://positivepsychology.com/3-resilience-scales/
Bandura A (2006). “Guide for constructing self-efficacy scales”. In Pajares F and Urdan T (eds). Self-efficacy beliefs of adolescents, pp.307-337.
Chowdhury M (2020). “What is emotional resilience and how to build it”. Positive Psychology, April 2020, www.positivepsychology.com
The Connor-Davidson Resilience Scale, http://www.connordavidson-resiliencescale.com/
Ellis A (1956). “An operational reformulation of some of the basic principles of psychoanalysis”. In Feigl H and Scriven M (eds). The foundations of science and the concepts of psychology and psychoanalysis. (pp 131-154). Minneapolis: University of Minnesota Press. (Also: Psychoanalytic Review, 43, pp.163-180).
Gonzalez S, Moore E, Newton M, and Galli N (2015). “Validity and reliability of the Connor-Davidson Resilience Scale (CD-RISC) in competitive sport”. Psychology of Sport and Exercise, 23, March 2016, pp31-39. Available online at https://www.sciencedirect.com/science/article/pii/S1469029215300194
The Resilience Scale, https://hr.un.org/sites/hr.un.org/files/The%20Resilience%20Scale%20%28Wagnild%20%26%20Young%29_0.pdf
Friborg O, Hjemdal O, Rosenvinge JH, Martinussen M (2003). “A new rating scale for adult resilience: what are the central protective resources behind healthy adjustment?”. Int Journal Methods Psychiatric Res, 2003; 12(2): pp.65-76.
Friborg O, Barlaug D, Martinussen M, Rosenvinge JH, Hjemdal O (2005). “Resilience in relation to personality and intelligence”. Int Journal Methods Psychiatric Res, 2005; 14(1): pp.29-42.
Johnston-Wilder S, Goodall J, Almehrz H (2018). “Overcoming Statistical Helplessness and Developing Statistical Resilience in Learners: An Illustrative, Collaborative, Phenomenological Study” Creative Education, 2018, 9, pp.1105-1122.
Kobasa S C (1979). “Stressful life events, personality, and health: An inquiry into hardiness”. Journal of Personality and Social Psychology, 37(1), pp.1-11.
Ponce-Garcia E, Madewell A, Kennison S (2015). “The Development of the Scale of Protective Factors: Resilience in a Violent Trauma Sample”, Violence and Victims, volume 30, number 5, 2015.
Rotter J B (1966). “Generalized expectancies for internal versus external control of reinforcement”. Psychological Monographs, 80, pp.609-611.
Rossouw, P and Rossouw, J (2016). “The Predictive 6-Factor Resilience Scale: Neurobiological Fundamentals and Organizational Application.” International Journal of Neuropsychotherapy, vo1 l4, issue 1, 2016.
Seligman, M (2011). “Flourish: a visionary new understanding of happiness and well-being”. New York, NY: Free Press.
Selgman M (2018). “PERMA and the building blocks of well-being”. The Journal of Positive Psychology, vol 13, https://doi.org/10.1080/17439760.2018.1437466
Smith B W, Dalen J, Wiggins K, Tooley E, Christopher P, and Bernard J (2008). “The brief resilience scale: assessing the ability to bounce back”. International journal of behavioral medicine 15(3), pp.194-200
Windle G, Bennett K M, and Noyes J (2011). “A methodological review of resilience measurement scales”. Health and quality of life outcomes, 9, 8 (2011). Available online at https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-9-8