Building Resilience - An introduction to the Space for Resilience program and the feasibility study

Most people will experience at least one highly stressful or traumatic event in their lifetime (Benjet et al., 2016). Research shows that the occurrence of these substantially increases an individual’s risk of experiencing poor mental health . For example, we might experience the death of a loved one, lose a job or live through a traumatic world event such as a natural disaster or indeed a pandemic. However, despite increased risk, the majority of people will not develop a serious or related mental health problem. In fact, some individuals may even be strengthened by or grow from their experience. This raises the question: in times of hardship, what gives people the strength to persevere?

During decades, the science of psychology has been trying to get a better understanding of this phenomena, which has been called, resilience. Simply put, resilience is the capacity to bounce back from stress. It has been shown to protect against burnout and the development of many common mental health problems. According to the current state of knowledge, resilience is not a stable personality characteristic within a person but is instead composed of several modifiable factors that mitigate the negative effects of risk. An important implication of this is that people are not born resilient; rather resilience is learned and developed over time. Following this line of reasoning, and in accordance with the growing emphasis placed on mental health promotion and prevention in recent years, interventions aimed at fostering resilience are becoming increasingly popular.


Space for Resilience is a new online program developed by SilverCloud Health that provides users with psychoeducation and tools to enhance their resilience and well-being. It is a broad program targeted at individuals in universal, preventive and remedial contexts aiming to enhance their general resilience and well-being, prevent future mental health problems or supplement face-to-face treatment. The program draws on the principles of positive psychology (i.e. the science of happiness and wellbeing) and incorporates mindfulness-based and cognitive-behavioral elements such as meditation, cognitive restructuring and behavioral activation. Using these strategies, the program promotes the development of a number of well-evidenced resilience factors including meaning or purpose in life, a sense of coherence, positive emotions, hardiness, self-esteem, active coping, self-efficacy, optimism, social support and cognitive flexibility (Helmreich et al., 2017). These factors are enhanced over a series of seven modules which include five core modules, each focusing on a different domain of resilience:

Building Resilience

The opening module introduces the concept of resilience and its five core domains: purpose, self, connections, body and mind. The user is invited to consider their strengths in each of these areas and set goals for the future. The practice of mindfulness meditation is also presented and its role in promoting mental flexibility and adaptability is explained.

mindfullness

Purpose

This module highlights the importance of having a clear sense of purpose in order to live a meaningful life and deal with setbacks. The concept of flow is introduced and users are encouraged to identify their values and passions and integrate them into their everyday lives. The user is also supported in finding a balance between the roles they play in key life areas (self, relationships and work).

Self

This module focuses on enhancing self-esteem and self-efficacy. Users are encouraged to build awareness of their personal and signature strengths, put them into practice and align them with their values and passions. The practice of self-compassion is also introduced and users are facilitated in replacing negative self-talk with kind and compassionate self-statements.

Connections

This module centers around strengthening relationships in order to foster a sense of belonging in users. The user considers their current social network and develops strategies to improve the quality of their personal relationships and community involvement. Lastly, information about communication styles is provided and users learn communication skills to build and sustain healthy relationships.

social-connections

Body

Maintaining a healthy lifestyle makes an important contribution to an individual’s resilience and overall well-being. This module provides information on the three central aspects of a healthy lifestyle (exercise, diet and sleep) and offers tips for developing positive habits in each of these areas. Behavioral activation techniques for building motivation are explored and the user reflects on the link between their lifestyle choices and mood.

Mind

The module explores the role of thoughts in developing resilience. The benefits of balanced optimism are considered and users learn to notice, evaluate and replace their negative thinking with a more positive, realistic outlook. The role of gratitude in cultivating balanced optimism is also considered and users are encouraged to make a habit out of focusing on the positive aspects of life.

Moving Forward

This module focuses on building active coping strategies. Users are supported in taking action over or changing their response to problems and a step-by-step guide for effective problem-solving is provided. Lastly, users reflects on the progress they have made in the five core domains of resilience and set additional goals for the future.

To examine the feasibility of the Space for Resilience program, we conducted a pilot randomized controlled trial with a sample of 83 college students in Dublin, Ireland (Enrique et al., 2019). Primary outcomes were measures of resilience (Connor-Davidson Resilience Scale; CD-RISC) and well-being (Pemberton Happiness Index; PHI) and secondary outcomes included measures of self-esteem, stress and symptoms of anxiety and depression. The program was delivered over an eight-week intervention period and participants who received the intervention demonstrated significant improvements in resilience, well-being, self-esteem and reductions in stress and symptomatology at post-intervention. Overall, users were satisfied with the program and were likely to recommend it to a friend or colleague, with approximately 79% of users saying that they found the programme helpful or very helpful. In particular, participants liked the accessibility and flexibility of the programme and endorsed its inviting layout and positive psychology approach.

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The programme is also currently being used in Talking Therapies, a mental health service within the Berkshire Healthcare NHS Foundation Trust, UK, where it has been well-received by psychological well-being practitioners (PWPs) supporting clients on the programme:

“I really like the way it incorporates positive psychology and CBT. I also find it really helpful for people who are at a change in role stage of life...”

“... it has given us an opportunity to really support and reach out to clients who have engaged a number of times and are experiencing recurrent depression... Not only this group, but a larger group with challenging unchangeable life events ongoing have found the programme to be extremely useful with fantastic recovery results.”

While further research is needed to evaluate the effects of the intervention on a larger scale, the pilot trial and qualitative feedback received provide preliminary support for the initial efficacy, acceptability and real-world benefits of the Space for Resilience programme. Importantly, the results of the pilot provide additional evidence that resilience is open to improvement. By developing the evidence-based skills and behaviours that promote positive adaption, a person can build their resilience and ability to overcome negative life events. Although we cannot always change a difficult situation, we can change the way we react and adapt to it, and in doing so, begin to see our problems as an opportunity to learn and grow.

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References

Enrique, A., Mooney, O., Salamanca-Sanabria, A., Lee, C. T., Farrell, S., & Richards, D. (2019). Assessing the efficacy and acceptability of an internet-delivered intervention for resilience among college students: A pilot randomised control trial protocol. Internet Interventions, 17.

Benjet C., Bromet E., Karam E. G., Kessler R. C., McLaughlin K. A., Ruscio A. M., … Koenen K. C. (2016). The epidemiology of traumatic event exposure worldwide: Results from the World Mental Health Survey Consortium. Psychological Medicine, 46(2), 327–343.

Helmreich, I., Kunzler, A., Chmitorz, A., König, J., Binder, H., Wessa, M., & Lieb, K. (2017). Psychological interventions for resilience enhancement in adults. Cochrane Database of Systematic Reviews, 2017(2).

Kalisch, R., Baker, D. G., Basten, U., Boks, M. P., Bonanno, G. A., Brummelman, E., ... Geuze, E. (2017). The resilience framework as a strategy to combat stress-related disorders. Nature Human Behaviour, 1(11), 784–790.

World Health Organization (2001). The world health report 2001 – Mental health: New understanding, new hope. Retrieved from https://www.who.int/whr/2001/en/whr01_en.pdf?ua=1