What do we want from a resilience intervention?

Even those interventions that do appear to have a clear aim and methodology can still produce varied outcomes. A 2017 systematic review of universal resilience interventions conducted by Julia Dray and colleagues found that many programs intended to confront mental health related issues through resilience education failed to live up to the hype (Dray et al., 2017). Dray and her co-researchers looked at 49 studies involving a number of different strategies, cohorts, time-scales and follow-up investigations. The purpose of the meta-analysis was to answer three main questions:

  • • Can interventions be effectively delivered by teachers?
  • • Are these interventions effective long-term?
  • • Do interventions have the same effect across populations and sub-groups? In addition, the review looked at four specific outcomes:
  • • Depressive symptoms
  • • Internalising problems
  • • Externalising problems
  • • General psychological distress.

Some of these interventions were delivered by teachers and some by clinicians and trained facilitators, while others were delivered by teachers or a mixture of teachers and clinicians; 31 of the interventions included CBT, while the remainder used life-skills, coping skills or psychological wellbeing techniques.

We can already see how difficult conducting such a review of interventions can be; they use different techniques, target different factors and include different cohorts and age groups. The conclusions of the review were equally mixed, for example, 15 studies found no difference in outcomes for depression while two found improvement; one intervention found an improvement for females but an increase in depressive symptoms for males. CBT interventions did appear more successful than non-CBT for depression, anxiety and general psychological distress.

What is also clear is that interventions don't always define resilience in the same way. If you were to ask your colleagues what they thought resilience was, I can pretty much guarantee that many of the descriptions would be different. There will be overlaps - bouncing back seems to be a common phrase used when discussing resilience, as is coping but, as with the questions I posed earlier, the definition may well be prompted by what could be gained by increasing resilience, such as higher levels of wellbeing, increased confidence or a reduction in depression and anxiety.

We, therefore, need to agree on what resilience is. Definitions are important; they allow us to identify what something is and what it is not. This might sound obvious, but I've spent many hours debating and discussing a myriad of topics only to discover that conflict has arisen because everybody is discussing something slightly different. It's also necessary for the chapters that follow, because they involve a very specific type of academic resilience that differs from many of those that describe resilience more generally.

To be honest, I'm not a great fan of the term resilience, certainly not in its multiple guises, but it's still important that we start somewhere and a definition is as good a place as any. In her now classic article, 'Ordinary Magic', Ann Masten described resilience as 'good outcomes in spite of serious threats to adaptation or development' (Masten, 2001). The key point to note here is that Masten is referring to more than just coping with competing deadlines or anxiety caused by high stakes exams. Furthermore, these threats must have some negative impact on an individual's ability to fully develop. A child who is raised by parents who are habitual hard drug users is unlikely to receive the nurturing and sensitive care that is needed for healthy development; a child raised in poverty faces challenges that could impact them both physically (for example, due to malnutrition) and psychologically (due to an increase in family stress). Similarly, young carers are in a position where they often have to skip certain natural development stages and grow up before their time so that they can successfully care for a chronically ill parent. Such extreme experiences are often referred to as Adverse Childhood Experiences (or ACEs) and can result in wide-ranging, long-term negative consequences.

Masten views resilience as part of the normal human process of adaptation. In other words, it's part of our evolutionary development, a means of increasing our chances of survival. If we look at resilience in this way, we reach the conclusion that resilient individuals aren't particularly special. Resilient people are resilient because they have faced adversity and come out the other side, a little battered and bruised perhaps, but with their resilience even stronger. This might also suggest that resilience is the result of something intrinsic to the individual, perhaps a personality trait or a specific gene or combination of genes that helps them to flourish while others might flounder. If we view resilience in this way, it becomes harder to teach because such traits, by their very nature, represent fixed and relatively consistent patterns of behaviour. We can also argue that resilience is a learned behaviour rather than a trait, but that doesn't mean that it doesn't present as trait-like, and this is where problems can arise, certainly in regards to methodology. An alternative is to think of resilience as a process-orientated behaviour, indicating that it is much more than just the ability to bounce back. Resilience viewed in this way becomes a behavioural outcome, leading to significant change in future behaviour and an increased capacity to turn setbacks into opportunities. This is perhaps more useful than identifying resilience as outcome-orientated, as an adaptive behaviour that alters dependent upon changing circumstances. These very precise distinctions don't matter that much here, but do emphasise the problems we face when attempting to identify the exact nature of resilience.

Ian de Terte and Christine Stephens of Massey University in New Zealand offer a simpler definition. Resilience is the 'ability to cope with crisis or to return to a pre-crisis status quickly' (de Terte & Stephens, 2014). What represents a crisis is obviously relative, but would still suggest that resilience is about adversity that goes beyond the day-to-day challenges faced by most people. Angie Hart of the University of Brighton offers a more useful definition: 'Overcoming adversity, whilst also potentially changing, or even dramatically transforming, (aspects of) that adversity' (Hart et al., 2016). But does this definition serve our specific purpose? Again, it depends on what our purpose is.

If resilience arises through adaptation, it could be quite confidently argued that those individuals who are more resilient are the ones who have successfully overcome hardship and adversity, adapting to these situations as they arise and developing resilience, grit or whatever along the way. These individuals are most likely to be (but are certainly not confined to) those raised in harsh environments, poverty or within severely dysfunctional families. Some young people, therefore, are already highly resilient as a result of the harsh environment in which they have been so far raised. But we still have to recognise that resilience isn't something some people lack - it's a natural component of the survival instinct - we are all resilient.

 
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