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Fostering resilience

02 June 2021
Volume 2 | British Journal of Child health · Issue 3

Abstract

The coronavirus pandemic has had a profound effect on children and young people's mental health. Stephanie Thornton discusses how child health professionals can encourage resilience in young people, to help them recover from the emotional distress of the pandemic

This has been a difficult year for young people (and for us all). Before the pandemic, around 10% of children aged 5–16 years had mental disorders, a figure that has now risen to about 17%, and the situation for 17- and 18-year-olds is worse (Office for National Statistics, 2020). These data probably underestimate levels of emotional distress, as they focus on diagnosable mental disorders, a strict criterion that excludes many levels of real depression and anxiety.

What can we do to support young people adversely affected by the stresses of the pandemic? One strong suggestion is that we might try to foster resilience, both in helping young people to cope with their current woes, and preparing them to respond more robustly to future events in what is now a strangely uncertain world.

There are marked individual differences in resilience (Ellis et al, 2017; Lionetti et al, 2018). Lionetti and her colleagues identified three personality types characterised by differences in resilience. These are: ‘dandelions’, so called because, like that hardy plant, these individuals are resilient, robustly thriving even in adverse circumstances; ‘orchids’, who, like that tender flower are much more vulnerable in adverse circumstances, and easily damaged; and ‘tulips’ who fall somewhere between these two. Over various studies, Lionetti and her colleagues found that 25–35% of children and teenagers score as dandelions, 41–47% as tulips, and 25–35% as orchids.

‘The roots of individual differences [in resilience] lie in innate temperament, which is very strongly influenced by genetics…But genes do not wholly determine how robust a personality an individual develops’

Where do these differences in resilience come from? There are many different theories (Shean, 2015), but the general consensus across these is that there is a genetic component to resilience (Maul et al, 2020). The roots of individual differences lie in innate temperament, which is very strongly influenced by genetics. From birth, some babies are easy going and robust, others are irritable and easily distressed, and most are somewhere in between (Rothbart, 2011). However, genes do not wholly determine how robust a personality an individual develops. Innate temperament is the starting point, but personality is also profoundly shaped by families and parenting styles (Masten, 2018), and continues to be shaped by social experience in school and the wider community. Thornton and Gliga (2021) provide a review of this complex process. Innate temperament is with you for life, but the personality that develops from it is far more mutable, making the prospect of fostering resilience a real possibility.

Individuals with high resilience tend to have a positive orientation to life and a ‘can do’ self-belief (Hauser et al, 2006), but this is not enough to ensure that young people will cope robustly with either everyday setbacks or serious adversity. To be resilient, young people not only need self-belief but effective mental strategies. Research has shown that resilient individuals are also characterised by a high degree of cognitive or executive control, the ability to focus attention, to evaluate what is or is not working, the ability to switch attention to new strategies flexibly and the ability to regulate emotional reactions (Hauser et al, 2006). These things can be learned, although executive control of thoughts, behaviours and emotions is easier for some temperaments than others.

What is the best way to foster resilience, particularly in ‘orchids’? As of yet, there is remarkably little research directly addressing this issue. However, developmental psychology provides some suggestions.

Should we bolster self-esteem?

As noted above, resilient individuals tend to have good self-belief, a positive ‘can cope’ attitude. Individuals without such confidence are less likely to even try to overcome setbacks and traumas, and are more likely to be cast down. A first step in building resilience would therefore seem to be to bolster self-confidence in those who lack it. However, the research sounds a warning here. Self-esteem is constructive when it is based on reality. But when it is decoupled from reality, from actual abilities and capacities, it is counterproductive, undermining resilience (Twenge and Campbell, 2009; Grubbs and Exline, 2016). Confidence without foundation sets the individual up to fail. This poses real challenges in how to intervene to build appropriate self-confidence. Hints come from studies of the effects of different forms of praise (Cimpian et al, 2007): offering generic praise (for example, ‘you're so good at drawing’) encourages children to believe they have a stable trait or ability, building a fragile confidence that is easily undermined by setbacks such as failure or criticism. By contrast, offering specific praise (for example, ‘that's a very good drawing’) is rewarding without leading to false confidence. Children offered specific praise are more likely to respond resiliently to failures or criticism in a drawing task, seeking ways to rectify failings or solve problems (Cimpian et al, 2007).

Self-esteem can build resilience in children, but it must be based on reality to be constructive. Self-esteem and confidence that is not based on actual abilities and capacities undermines resilience and sets an individual up for failure.

‘…offering generic praise (for example, “you're so good at drawing’) encourages children to believe they have a stable trait or ability, building a fragile confidence that is easily undermined by setbacks such as failure or criticism.’

‘An everyday intervention to foster a positive attention bias is to ask young people to list, at the end of each day, five blessings experienced that day (for example, that lovely smile from a friend…)’

Encourage exploration of different perspectives

It is common to hear individuals of all ages attribute their reactions to circumstances (for example, ‘the pandemic made me feel…’). In reality, no external event or circumstance can make us feel this or that; there are always different ways of reacting and we can choose (Siemer et al, 2007). The resilient are better at recognising that fact, and exploring new responses (Hauser et al, 2006). One way to encourage young people to explore different reactions to a stressor is through group discussions, exposing them to other people's perspectives and ways of reacting, which may come as a revelation.

Suggest strategies that foster cognitive control

Anything that interrupts an impulsive or reflex reaction to setbacks lays the groundwork for the more reflective cognitive control that is conducive to resilience. ‘Count to ten before you lose your temper’ is a familiar everyday strategy. Another effective strategy is the ‘rule of five’: in almost any situation, there are always five possible interpretations or perspectives, and there are always five possible reactions (McManus and Thornton, 2006). Stopping to identify these provides a basis for executive choice rather than reflex reactions.

Encourage ‘living in gratitude’

Recent research has reported that those who live in gratitude are happier, more optimistic and more resilient than those who do not (Smith, 2020). ‘Living in gratitude’ is a bias toward the resilient strategy of noticing that there are good things in our lives, whatever setbacks or traumas we may be experiencing (Emmons and McCullough, 2004). By contrast, a negative attention bias, which hones in on the downsides of any situation, is associated with depression, anxiety and low resilience (Waters et al, 2013; Duque and Vazquez, 2015). Research reports various ways to shift a negative attentional bias toward a positive one, from simple tasks such as asking young people to find the one smiling face in an array of angry ones (Waters et al, 2013) to asking individuals to repeatedly write letters of gratitude to someone, whether they post the letters or not (Wong et al, 2018). These interventions are reported to be effective, with gains generalising beyond the tasks and maintained for weeks after the study ended. As of yet, these are small scale studies needing replication, but the data are encouraging. An everyday intervention to foster a positive attention bias is to ask young people to list, at the end of each day, five blessings experienced that day (for example, that lovely smile from a friend, the pleasure of helping mum with the supper, the joy of the sunny afternoon – and so on). Those with an initially negative attention bias find this task very hard at first, if not impossible. But the daily effort to find five things to list can lead to a shift in attention to look out for blessings, and hence a move toward living more positively.

In summary, resilience is important in maintaining wellbeing, and it can be effectively fostered in the young.