Resilience is our ability to recover from tragedy. It’s a quality that trauma professionals need all the time — so why then do we wait to discuss resilience only after a mass casualty incident like the Las Vegas shooting dominates the news?
Simply, we should not. Your level of resilience is greatly influenced by your prior experiences, so the time to start laying the personal groundwork for greater resilience is now.
That means paying attention to how you manage the daily stressors you endure as a healthcare provider who deals with trauma. The cumulative effects of these stressors can undermine your personal resilience. When tragedy does strike, the result may be a decreased ability to respond effectively to the situation, greater challenges in recovery, and a vulnerability to traumatization.
Regardless of your degree of resilience, coping with painful emotions brought on in the aftermath of tragedy is a demanding mental process that can leave the fittest feeling drained, disconnected and increasingly anxious. And unfortunately the psychological toll is often unacknowledged, underreported and poorly managed. The opportunity for downtime to recover after an adverse event can be elusive or even discouraged. This approach is a disservice to the individual, to future patients and to the hospital.
No one is impervious to tragedy’s impact. Our call of duty necessitates continual involvement in an incident response that can last for days and weeks. For some, this response can go on for years. Therefore, it is essential to our occupational effectiveness and overall well-being to protect against the emotional hazards of trauma-response work. The first step is to understand your personal response patterns.
The 3 common response styles
Understanding your particular style of responding to tragedy can help you facilitate your personal recovery in its aftermath. Three styles are common:
Avoidant. Individuals with this response style tend to focus on tasks during a crisis and avoid their negative emotions. They mute or “table” their emotions by “doing” things that help address the crisis (e.g., they focus on “what needs to be done”). Once the tasks are completed, these individuals report experiencing their emotions more fully. In some cases, the emotions hit only days or weeks after the tragic event.
Avoidant individuals may readily engage tasks and activities during a response and can be invaluable in helping to mitigate crises. However, if the response is prolonged or recurrent so that they remain in “task mode” for weeks or months, the tabled emotions can accumulate. When this occurs, the individual may begin to experience strong, potentially debilitating emotions in response to even minor events.
For this response style, consider a routine that affords you reflective moments. You might take a drive with the radio off, relax outdoors in a hammock, sit out by a lake or the ocean, or journal a paragraph or two. These activities will enable you to connect with the “tabled” emotions. Allowing time to express these feelings in some form — whether it be art, talking, writing or praying — will help keep the “tabled” emotions from piling up over time and becoming destructive.
Ruminative. Individuals with this response style do not disconnect from their emotional experience during a crisis. Instead, they function while simultaneously experiencing the profound negative emotions precipitated by the event. In the hours and days that follow, they tend to catch themselves thinking about aspects of the tragedy while at home and off duty. Often, these individuals reflect on these situations and problems subconsciously.
The upside of this style is that it can lead to creative solutions. People who use this type of contemplation are often able to develop new, creative measures and innovations to these situations. The downside of this style is that constant rumination is mentally and emotionally exhausting. Ultimately, burnout is a real danger for those with this style — especially if they experience crisis after crisis.
To avoid this downside, trauma professionals with a ruminative response style must allow their brain to recharge by “changing the channel” every so often. Consider activities that temporarily focus your attention away from the unresolved situations and problems. For example, take some time for sports or an exciting recreation, or have an engaging conversation with a good friend that does not focus on the problem. Even a few minutes of diversion can yield significant rejuvenation.
Hypervigilant. Individuals with this response style are able to think accurately and quickly, and take decisive action in the most intense situations that leave most others overwhelmed. This capability is due to physiological changes during very high stress that make the individual more alert and responsive. However, once a crisis is resolved these individuals may experience several hours of low energy and disengagement.
Because hypervigilance is driven by the body’s release of stress hormones, constant hypervigilance can decrease the body’s ability to release these hormones. Over time, chronic high stress conditions can burn out the endocrine systems specifically impacting endorphin levels. Endorphins block pain and induce a sense of pleasure and well-being. When these levels are compromised, endorphins will only get released under conditions of high stress. Without high stress, individuals with burned out endocrine systems do not feel “right”, and they tend to feel better under high stress when the endorphins are again released.
To prevent this system from burning out, hypervigilant individuals should consider establishing a routine that involves regular physical exercise. Cardiovascular exercise mimics the body’s fight or flight response through movement of the arms and legs. As a result, it decreases the stress hormone elevation in the body after periods of high stress. A regular cardiovascular workout returns elevated stress hormone levels back to their baseline. When exercise occurs on a consistent basis, it thereby protects the body from stress damage over time and keeps the endocrine system responsive and healthy.
Are you dedicated to reducing the burden of traumatic injury? Read the only publication focused on trauma leadership and management: Trauma System News. To subscribe for free, click here.
It is not unusual to identify with two or even all three of these response styles. This is why it is important to develop a self-care routine with a broad repertoire of healthy activities. If possible, seek activities that match the response style or styles that crisis elicits within you. It just may optimize your recovery in the short run and sustain your longevity over the years.
The 3 pillars of resilience
As daily stressors have a cumulative impact on resilience, so do healthy routines. Building your health before a crisis will facilitate your resilience when tragedy strikes.
The following three pillars of resilience are not just helpful in the immediate aftermath of a trauma response; they are also applicable across everyday life.
Cultivate your social support networks. The reason for this is two-fold. First, you must feel safe openly discussing your feelings about an adverse event with colleagues who understand the stresses of the job. In this respect, healthy and supportive work relationships are essential.
Second, relationships with family and friends are important to remind you of the roles you have outside of work — that you are a spouse, partner, parent, sibling and friend. Resilience allows you to continuously transition between work and these various roles while on the path to recovery.
Engage habits of physical self-care. The best research supports maintaining your cardiovascular health through regular physical activity. Keep it simple. Whatever activity works for you, do it!
Stay connected to what brings you meaning and purpose. Recovery is not linear, nor does it have an end date. You must make sense of any adverse event and integrate it into your life. For some, that is through spirituality or religion. For others, the way forward is to use your experience to help others get through tough times.
The goal is to thrive
The goal of resilience is to thrive after an adverse event. Not succumb to its negative effects. Many of us will begin our journey of resilience with no map or guidebook. It takes time to understand your response and more time to incorporate the right balance of activities and support for successful recovery.
And remember, the journey begins long before an adverse event occurs. Advance preparation will greatly enhance your chance for successful recovery.
So what will you do today to stock your resilience toolbox?
Brian H. Williams, MD, FACS is a trauma surgeon and keynote speaker based in Dallas, TX. He blogs at brianwilliamsmd.com.
Rick Williamson, PhD is a clinical psychologist and co-founder of Emmada Psychology Center (www.emmadapsych.com) in Los Angeles, CA.