Dr Jacqueline Boyle, Consultant Clinical Psychologist

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

jacqueline.boyle@midyorks.nhs.uk
anita.wraith@midyorks.nhs.uk
 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 16.5.16)

• “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

Ability to establish a
Adapting under
sense of community
pressure
at work

Control over own Thriving despite or

workflow because of pressure

Being strengthened
Ability to foster
or improved by
good relationships
adversity

Positive emotions
Positive response to
(buffer against
change
depression)

Emotional flexibility

Source: Chichetti, 2010

Three Layers of Resilience:
Individual Resilience

• Individual coping skills

• Personal values – compassion, professionalism etc
• Feeling valued in your role with patients
• “Gallows humour”

Interpersonal / Team Resilience

• Team relationships
• Social Support
• Mentoring / sharing ideas / supervision

Organisation Resilience

• Leadership (NHS Confederation, 2011b)

• Creating learning opportunities and development from mistakes

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?
 Self Care: Social Support
Sleep, – Friends,
Nutrition, Work-Life family &
Exercise Balance colleagues

Generate Hobbies &

Helpful Interests
Spirituality thoughts Acceptance

Meaningful Be decisive
Activities
Opportunities
for learning Self
after adversity soothing Relaxation
Realistic Meditation
Goal Setting
Resilience Skills

Balance & Emotional

recovery resilience

Resilient
thinking
Flexible
Optimism
thinking
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)

Thoughts

Physical
Feelings
response(s)

Behaviours

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
We can do nothing about the
Face up to but do nothing event as it’s too big for us to
Face up to, overcome the event
about the event deal with (withdraw until the
event has passed vs. ‘act out’)

• And ultimately • & still benefit • Flight or fight

benefit 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

Thoughts

Physical
Feelings
response(s)

Behaviours
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. 2012. Personnel Today [Online]
http://www.personneltoday.com/hr/understanding-the-importance-of-
resilience/
• Andrews, S. & Thorne, F. (2015) What do people need to be resilient in the
current NHS? Clinical Psychology Forum, 276, 12-15.
• 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), 29-41.