Illness, fear, loss, grief, isolation, uncertainty, and unemployment are just a handful of the profound consequences of the pandemic — with many experiencing multiple issues simultaneously. And with cases still spiking across the country and likely worsening this winter, the current U.S. death toll of over 307,000 will just keep rising, and lockdowns and anxiety will persist. The pandemic has pushed us to our limits, but we’ve used our resilience to push back and keep going. As we near the end of this unthinkable year and look forward to a new year that we know will continue to present challenges, one thing we can do to help ourselves is to take some time to store up our resilience reserves. To see what the rest of the country thought about resilience, we put together the comprehensive report, below, partnering with wellness experts and researchers at The Ohio State University to conduct a national online survey: The State of Resilience. A total of 3,583 people ages 13 to 73 took our online survey to help us better understand how Americans define resilience, what challenges our resiliency, and what makes us resilient. The biggest “aha” insight our survey takers revealed? The majority of Americans overestimated their own resilience — by a lot. In fact, 83 percent of Americans polled thought they had high levels of mental and emotional resilience, when in fact 57 percent scored as resilient. Why is this important? Because growing research shows higher levels of resilience are directly related to better outcomes when living through a crisis, managing chronic disease and chronic pain, and improving emotional and physical health. To see where you stand and what you can do to become even more resilient, read this report by award-winning writer Abby Ellin, and then take the Everyday Health Assessment: Get Your Resilience Score. The assessment is based on 15 years of scientific research from one of the country’s top resilience experts, Everyday Health Wellness Advisory Board Member Amit Sood, MD. Dr. Sood is the executive director of the Global Center for Resiliency and Well-Being, creator of the Resilient Option Program, and former professor of medicine at the Mayo Clinic. We also have an in-depth guide, “What Is Resilience?: Your Guide to Facing Life’s Challenges, Adversities, and Crises,” written by Katie Hurley, licensed clinical social worker, and reviewed by Allison Young, MD, a psychiatrist and member of Everyday Health’s medical review board. You’ll learn how to cultivate resilience and hear from celebs like Randy Travis, Jennifer Hudson, and soccer superstar Lionel Messi on how they did the same. You’ll get our recommendations on the top TV shows, books, and films for inspiring and learning about resilience; learn how to teach kids and teens resilience; and find out whether gender affects resilience. We feel so strongly about what we’ve learned the past six months about resilience — namely its connection to your physical, mental and emotional, social, and spiritual well-being — that we believe taking steps to learn how to become more resilient will help you get through this crisis and see beyond to the other side. The payoff for putting in the extra time and effort to become more resilient? Less of the stuff you don’t want: fear, anxiety, feeling overwhelmed, depression, sadness, and hopelessness. And more of the stuff that can benefit you in times of crisis and in everyday life, including a sense of hope and satisfaction with yourself, your relationships, your work, and your life overall. — Maureen Connolly, Editor in Chief
Eighty-three percent of Americans polled thought they had high levels of mental and emotional resilience, when in fact only 57 percent scored as resilient after taking an assessment to measure their personal resilience.Ninety-one percent of the most resilient Americans believe mental health is as important as physical health. Yet only 33 percent of Americans are likely to ask for help or counseling when faced with a negative situation that is emotionally taxing.Less resilient people have a passive, “it is what it is” mindset. They also spend time overthinking or overanalyzing issues and shy away from in-person interactions. Resilient people “keep their challenging situations in perspective.” Sixty-three percent “don’t sweat the small stuff versus overthinking things.”Boomers and Gen Xers share the same self-reported resilience ratings: Sixty-seven percent of boomers and 62 percent of Gen Xers rate themselves as “more resilient” compared with 37 percent of Gen Zers.Gender and ethnicity matter. Sixty-two percent of black or African Americans say they’re resilient while just 46 percent of Asian Americans say the same. And when it comes to gender, 59 percent of men in our survey were resilient compared with just 54 percent of women.Good news: In general, the majority of Americans (89 percent) know what it takes to be physically well. Not so good news: A disconnect between financial health and emotional wellness. Only 50 percent of respondents believe financial wellness affects personal wellness, yet financial insecurity is a big driver of stress today.Going through a tough time? The most common responses people said they hear are “Are you okay?”, “How are you doing?”, and “Everything will be okay.” But the top three statements people said they like hearing the most are “I’m so sorry, I love you”, “Remember that time when … ?" (telling stories of lost loved ones), and “Let me know if there is anything I can do.”When looking at the associations among resilience levels, disease, and mental health, those who scored as less resilient reported a higher prevalence of asthma and irritable bowel syndrome (IBS), and were also significantly (51 percent) more likely to report a diagnosis of clinical depression, anxiety disorder, PTSD, bipolar disorder, ADHD, OCD, or an eating disorder.Resiliency role models for people of any age? Oprah, Ellen DeGeneres, and Nelson Mandela topped the list — in that order.
The evidence on resilience, which is often defined as the ability to cope or adapt when confronted with adverse life events, is mounting. Thousands of studies over recent decades show that people of all ages who are resilient tend to have better health and well-being outcomes than those who do not possess resiliency. I have devoted my career to developing and testing cognitive behavioral intervention programs to improve mental health outcomes in children, teens, and young adults at risk for or suffering from depression and anxiety. Findings from my body of 17 studies, including a large clinical trial funded by the National Institutes of Health and National Institute of Nursing Research, support that COPE, or Creating Opportunities for Personal Empowerment (also known as MINDSTRONG for college students at The Ohio State University), is effective in enhancing self-esteem, resiliency, and coping skills to prevent or lessen mental health problems. My own research along with other studies support the idea that individuals can learn techniques to build resilience. These include learning cognitive behavioral skills to turn negative thoughts into positive ones; taking good self-care; reading five minutes every morning from a positive book; engaging in positive self-talk; naming people and things for which you are grateful every day; viewing crises or stressful challenges as “character builders” instead of intractable problems; staying connected to others and sharing feelings with them; learning to accept change as part of life; and keeping things in perspective. This report adds new and exciting insights into resiliency across multiple generations, based on solid research findings that extend what is known on this topic. I encourage you to take your time in reading it, think critically about how you can further build resiliency, and make a commitment to put into daily practice some key strategies to enhance your own resilience. Remember, it takes practice and time to build resilience, so don’t give up. Keep trying, as the result will be well worth it. Bernadette Mazurek Melnyk, PhD, RNVice President for Health Promotion and Chief Wellness Officer at The Ohio State University; Executive Director for the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare; Dean and Professor at The OSU College of Nursing Indeed, being a person in the world today requires extraordinary fortitude, gumption, and resilience, what Everyday Health Wellness Advisory Board Member Dr. Sood describes as “the core strength you use to lift the load of life.” “Resilience is doing well when you shouldn’t be doing well,” says Sood, the executive director of the Global Center for Resiliency and Well-Being in Rochester, Minnesota, and creator of Mayo Clinic Resilient Mind. “It’s your ability to withstand adversity and bounce back and grow despite life’s downturns.” Growth in the face of adversity can be life-changing in many ways. “There are costs to surviving and to recovering — physiological, psychological, emotional,” says Arline T. Geronimus, ScD, professor of health behavior and health education at the Institute for Social Research at the University of Michigan in Ann Arbor. “There can be growth or new direction to your life. For better or worse, you are not the same.” RELATED: Should You Get a Personal Trainer? Jennifer Ashton, MD, the chief medical correspondent for Good Morning America, credits the years she spent playing lacrosse and field hockey with helping her be more resilient after her ex-husband died by suicide. RELATED: Can Getting Mentally Tough Up Your Game? In All Sports, the Answer Is Yes But it’s not just about athleticism. Ashton has also had three operations. “I know what it feels like to be in pain and then recover,” she says. “You don’t have to be athletic to develop resilience with a physical nature. “There’s this relentless drumbeat around being happy, and it’s very hard because it’s a nebulous concept,” she says. “Having it as an overarching goal of the human condition is selling everybody short, because there are very important things we all strive for, which is feeling fulfilled and having purpose and finding meaning in what we do. Focusing people’s behavior on being happy doesn’t give people the capacity to learn and grow when they’re not happy.” Learning to deal with adversity rather than focusing on happiness improves the chance that you will one day feel good again. As she puts it, “Resilience provides you with a personal foundation of strength and sense of safety.” Studies have shown that characteristics associated with resilience, such as optimism, self-worth, and social support, can improve health outcomes in people with chronic conditions. On the other hand, low resilience has been linked to worsening of disease activity and reduced quality of life. The following are just some examples of research examining the connection between resilience and specific conditions or disabilities:
Studies have shown that optimism and perceived social support help improve quality of life for rheumatoid arthritis patients. (6)Research published in March 2018 in the Journal of Psychosomatic Research found an association between traumatic experiences, low resilience, and reduced quality of life in psoriasis patients. Improving resilience through early psychological intervention helps facilitate management of the disease. (7)A study published in 2015 in the journal Cogent Psychology, which looked at resilience and chronic diseases such as diabetes and rheumatoid arthritis, supported the idea that physical resilience can reduce the adverse effect that stressors have on the immune system. (8)Resilience is thought to be a protective factor against psychiatric disorders, and researchers found that patients who had attempted suicide had significantly lower resilience scale scores than patients who never attempted suicide. (9)Studies, including one published in 2017 in the journal Archives of Public Health, have suggested that resilience strategies may help improve blood sugar management in people with type 2 diabetes. (10)Research published in June 2017 in the Archives of Physical Medicine and Rehabilitation showed that resilience plays a unique role in quality of life issues among people with physical disabilities. (11)
Indeed, you don’t know what you’re capable of until challenged. Ashton, for example, always thought she was a resilient person. In medical school, she worked 90-hour weeks, sometimes staying up for 36 hours at a time while raising her two children. “I completed all of my classwork and graduated on time,” she says. “If you asked me if I was resilient, I’d have said ‘yeah.’” But she had no idea just how strong she was until 2017, when her ex-husband, surgeon Robert Ashton Jr., jumped off the George Washington Bridge. Not only did she have to reckon with her own pain and guilt while caring for over 2,000 patients, but she was now a single mother to two grieving kids. Ashton had inner reserves to call upon, but Sood says science has shown that anyone can increase their resilience. Even if you don’t naturally possess the resilience “gene,” he says resilience can be learned, developed, and acquired — and it doesn’t require a huge investment of time or financial resources. In April of last year, Susan Cooper, 77, an entrepreneur in New York City, lost her husband, David, of 56 years. For her, resilience is action-oriented. David was diagnosed with pulmonary fibrosis in 2012, and told that he had two to five years to live. “In 2013, his tests and chest X-rays had not changed that much.” He was okay, basically, until 2016, when he needed an oxygen tank. By 2016, he was using portable oxygen tanks and they began to keep small oxygen tanks in the house. “More than once, I was tempted to put a pillow over his face,” she says. “I didn’t do it. I got bigger and better oxygen.” After he died, Cooper — who says she adored her husband, raised two kids with him, traveled the world with him, and considered him her best friend — missed him terribly. She goes to a grief support group to help with the loss. But she also decided that Philadelphia, where they lived, was not the place for her to build a new life. “I needed to create a new community,” she says. She put their loft on the market three weeks later and moved into a Manhattan loft. “I needed to get on with my life,” she says. “Isn’t that resilience?” According to Darlene Mininni, PhD, MPH, a learning and development health psychologist at the University of California in Los Angeles, “Resilience is built upon a collection of teachable skills that strengthen our mental flexibility, emotional awareness, and feelings of connection.” Dr. Mininni, who’s also a member of the Everyday Health Wellness Advisory Board, says that resilient people “use these skills to navigate the ups and downs of their lives, and they benefit with a greater sense of well-being, optimism, and life satisfaction.” “We have tried to strategically place resilience practices at transition points during the day, where investing two minutes of time can produce benefits of four to six hours,” he says. “Say you are going into a difficult meeting. You invest 10 seconds and remind yourself why are you grateful to the person you’re going to meet. The moment you’re reminded of that, your day changes.” According to Sood, we derive resilience in two different ways: from the inside out and from the outside in. Resilience from the inside out is derived from your own inner resources: your conviction, self-love, and self-compassion. It comes from your faith, hope, positivity, courage, and gratitude. Resilience from the outside in comes from the people around you: those who love, value, and support you, including our family, neighbors, and colleagues. As we get older, we have the ability to develop this inside-out approach to resilience. Not that you don’t need to surround yourself with supportive people, but it’s the internal dialogue that matters more. It’s called reframing (or “spinning,” in political circles). But the idea is to reframe a thought or idea toward a more neutral stance. “I think truth has two sides to it, and it all depends which side you focus on,” he says. “’I lost my wallet but I am grateful it didn’t have any credit cards in it.’ Or ‘I have a flat tire but am grateful I have a spare.’ When you’re driving, you can end up in a ditch or get up on the highway. Reframing gets you back on the highway.” For children, external resilience is more important to cultivate than internal, “Because kids’ brains are like freshly poured concrete,” he says. “You scratch a line in it and it becomes a scar. They don’t have the resources to overcome critiques or abuse. So children depend a lot on family, community, teachers, and society at large. They still have their individual dispositions, but it’s largely the outside world that affects them.” “One way of looking at that is that the brain can get ‘stuck’: This is a lack of resilience, a lack of the normal ability of nerve cells, even after they have shrunken, to grow back — or after they’ve grown, to shrink back to their normal state,” says McEwen. “Doctors can then help promote resilience using behavioral therapies, including increasing physical activity,” says McEwen. Sometimes pharmacological agents are used in conjunction with these other methods, he explains, but the importance of the behavioral therapies cannot be overlooked. “Physical activity seems to open windows in which resilient plasticity can occur.” Studies have shown that the brain can change at any age. “When you practice some of these ideas, then the prefrontal cortex increases and the amygdala, the fear part of the brain, becomes less active,” says Sood. “Ten to 15 years later, there’s also evidence that not only their kids have retained a certain amount of plasticity in their brains, but also that there’s less diabetes,” says McEwen. “Promoting better relations between adolescents and parents, and building self-esteem and agency enables the child to be resilient as they go forward in life to fight bullying and to be self-controlled in making healthy choices, not only in diet and physical activity, but in relationships and priorities for school.” “The idea that there’s a window of opportunity even before early trauma, that allows the child, with the help of the parent, to build a better sense of themselves and develop the resilience that they need to handle themselves in the culture, is the only way to explain this. They’ve developed the ability to handle problems. It’s not innate.” When she was 14, Sydney lost her mother to breast cancer. To reduce her own risk, she opted to undergo a prophylactic mastectomy last year. But in August, just a couple of months following the surgery, horrendous stomach pains sent her to the ER. She spent the next 17 days undergoing multiple ultrasounds, CT scans, and, finally, exploratory surgery. Then came the diagnosis. Sydney endured multiple rounds of radiation, continual chemotherapy, and brain surgery to remove a metastasized tumor. “To say it’s unfair would be an understatement,” she wrote. “In truth, I believe it’s hard to explain why cancer happens to one person and not another. And the unfairness of it is impossible to rationalize. So I don’t try.” Tragically, Sydney passed away on September 4. She was 22. But Sydney lived her life in a way that exemplified resilience. “I have learned that being brave, being a warrior, and being strong do not mean fearlessness,” she wrote. “Coping with a cancer diagnosis is about standing in that fear and saying, ‘I choose to live a beautiful, passionate, impactful life.’” Those who are less resilient tend to be weak, fearful, and withdrawing, experts say. They don’t take opportunities, and frequently run away at signs of distress. Among the less resilient, “Negative self-talk is a huge challenge,” says Melby-Oetken. “’Oh my god, I’m never going to overcome this, this is the worst thing that can possibly happen. Why should I put effort into it if it’s not going to change?’ Any negative thinking patterns kill energy and makes people feel hopeless.” Melby-Oetken tells her clients to focus on the narrative they tell themselves, and then revise it. Say you’re going through a divorce. Rather than lamenting a horrible situation for you and your children, she advises you to “rewrite” the story. Instead of beating yourself up, you’d acknowledge that while the scenario is hardly ideal, it’s where you are right now. So your best option is to tell yourself it’s an unfortunate circumstance, accept it for what it is, and move on from there. Clearly, this isn’t as easy as it sounds. In general, most of us possess a ‘negativity’ bias — meaning, we’re more attuned to negative situations than positive, says Sood. “If I ask you how many people have hurt you in life, you can tell that quickly,” he says. “They occupy a disproportionate real estate in our head. You have 50 square feet for people who love you and 500 square feet for people who hurt you. The idea is to focus less on the negative experiences and more on the positive. It’s about shifting your attitude.” Sood believes that resilience is a skill that can be developed by focusing on five principles: gratitude, compassion, acceptance, meaning, and forgiveness. To build resilience, we can reframe the way we think about each one. Certain practices, like gratitude, compassion, sense of purpose, and focus, can help build resilience, says Sood, when used to handle life’s challenges. For example, says Sood, “Can we find gratitude for what went right within what went wrong? Can we have self-compassion for our struggles instead of self-judgment for our mistakes? Can we choose to accept that with two-thirds of the Earth covered with clouds, it’s going to rain on our backyard some day? Each of the five principles engages the brain’s higher cortical areas and quiet the reactive parts (this change correlates with resilience), helping you live a happier and more fulfilled life.” But it’s also important to recognize that only so much is within your control. Rather than worry about the horrific possibilities, focus on what is. “Life is like a long drive not knowing how much gas is in your car. No one knows,” he says. “So don’t think about what is going to happen six months from now. Make a plan for it, but live day by day.” The proper term is “distress tolerance,” and it refers to one’s capacity to withstand adversity. While part of that is innate, your life experiences also help shape that, Dr. Ellenhorn says. Ashton, for example, developed a high threshold for stress in childhood. Her parents divorced when she was 4 — and then remarried a few years later, only to divorce again when she was 22. She went to a demanding high school, but her parents insisted she could handle whatever was thrown at her. “One parent was very nurturing and the other told me to keep raising the bar higher to see what I could achieve,” she recalls. “Together, it bred distress tolerance and resilience.” Playing sports also helped, because it made her able to deal with physical challenges. RELATED: 7 Fitness Pros Who Have a Totally Balanced Approach to Wellness Studies have found that white Americans tend to be less resilient than minorities. (16) Why? It’s complicated. But minority groups tend to have more experience with adversity, especially economic and social. So they’ve had more of a need to figure out how to handle stressors. To that end, research has found white Americans experience more depression and anxiety than black Americans, although some of this difference may be related to underreporting and increased stigma of seeking mental healthcare in black communities. (17) Studies of survivors of Hurricane Katrina yielded interesting results. Most people experienced mental distress and post-traumatic stress for years after the disaster. But a study published in the American Journal of Orthopsychiatry found that low-income, unmarried black female survivors showed enormous resilience after the storm. (18) While they did show an increase in psychological trauma, within three years they had managed to return to the pre-storm stress levels. About 30 percent of survivors experienced post-traumatic growth, meaning that they felt the disaster had made them stronger, more compassionate, and more empathetic. And what got them through? A strong support system: Friends. Families. Neighbors. “People kind of see disasters on TV and say, ‘How are these people ever going to build their lives again?’” says study coauthor Jean E. Rhodes, PhD, the Frank L. Boyden Professor of psychology and director of the Center for Evidence-Based Mentoring at the University of Massachusetts in Boston. “We see that the vast majority of people over time bounce back.” Most of them do so by choosing possibility over complacency. They reframe their thoughts to look at the brighter side. They rely on the kindness of friends, family, and strangers to support them. And when you do this, you feed the human spirit, which in turn fuels the physical, cognitive, environmental, and social-emotional self — the recipe for resilience. Additional Contributors: Kim Kovacs, Tom Carr, Dakila D. Divina, Maura Corrigan, Elizabeth DeVita Raeburn, Denise Maher, George Vernadakis, Ingrid Strauch, Melinda Carstensen, Amy Kraft, Sarah DiGiulio, Carolyn Fagan, Brianna Wesley-Majsiak, Anna Brooks, Jamie Putman, Margot Slade, Scott Moore, Justine Angelis, Beth Silvestri, Tiffany Szalay, Bethany Rouslin, Kristen Hom, Amanda Long, Nicole Vegliando, and Thomas Gavin.
