Resilience

The current environment in the NHS is a challenging one – as it has been for some years now. The constant reminder in the media of the impending cuts and forecasts of doom and gloom and the actual day-to-day challenges of doing more with less provide a demanding context. The pressure seems to be relentless.

How do you deal with this adversity? Do you flourish or flounder; cope or collapse? How do you avoid becoming a 'Doctor in difficulty'?

Do you have the resources to cope with the day to day and focus in the face of these potential threats? What is the difference between the person who seems to cope and take it all in their stride and indeed to thrive while others lose focus and energy and experience extended periods of low moods. The difference between these individuals is more than the difference between being an optimist and pessimistic although that certainly has an impact. The difference is often down to resilience.

Some of us are naturally more resilient than others – we were born that way; others have learned through experience (sometimes bitter) to ‘toughen up'; others have very low thresholds for tolerating pressure and stress. Susan Kobasa's important research conducted in 1985 found that those who were more resilient – better able to cope with pressure and stress – possessed what she called hardiness.

Those who were more hardy had developed a pattern of behaviour and attitudes which helped them to see stress as a normal part of life and therefore to cope more easily. The features of these coping behaviours were based on differences in attitudes to challenge, control and commitment.

Challenge: those who viewed the stresses and demands as a challenge as something to work on and engage with rather than something to surrender to coped better. Taking the attitude that this was a challenge to be managed enabled them to feel stimulated rather than overwhelmed. It energised rather than drained them.

Commitment: those who remained involved, engaged and connected with others rather than withdrawing and becoming isolated found life easier to cope with. Focusing on commitment enabled them to feel supported rather than alone. It helped them understand and get perspective.

Control: those who tried to find aspects of the situation they could control, who continued to try to influence events and did not waste mental and physical effort on those aspects that were outside of their control did better. Feeling in control empowered them rather than feeling hopeless and helpless, a doctor in control rather than a doctor in difficulty.

We can learn to be hardy. Each of us needs to find the right balance between too little or too much commitment, control and challenge. Finding the right balance for yourself may help you to understand what is going on around you better and to reflect on what you might or might not be doing which could make your personal situation better or worse. You will develop hardiness to resist panic and find opportunities or understanding that leaves you feeling calm, capable and competent.

This is not to say that if you are hardy that you will enjoy the pressure and stress or that you will never find it difficult, annoying or become down hearted. Instead you are likely to manage it rather than let it manage you. You are more likely to be mindful of how it is impacting you and take action if that impact is something that you don't like. You will be better able to resist doing or saying the first thing that comes to mind which you might regret later. You will be easier to live and work with because you will be able to empathise with others and not focus only on your own needs – you will get support. Your approach to problem-solving is likely to be focused and realistic rather than scatter-gunned. In short, you will feel that you are coping rather than crashing!