October 2017 Ask the Expert: Resilience and Post-Traumatic Growth
The dictionary defines resilience as “the ability to become strong, healthy or successful again after something bad happens.” After cancer, resilience is recognizing the challenges brought on by diagnosis and treatment while taking steps to cope and move forward.
Tapping into your resilience may even result in post-traumatic growth, PTG, change for the better that comes after struggling with a major life crisis, such as cancer.
In October, Living Beyond Breast Cancer experts Susan Ash-Lee, LCSW and Jill Mitchell, PhD, LCSW, OSW-C answered your questions about resilience and breast cancer. They addressed what resilience looks like in everyday life, how it can affect your experience with breast cancer, how to increase your resilience, and more.
Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare provider because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.
First of all, let’s clarify what "resilience" is. People have defined resilience in various ways. Some see it as “bouncing back from adversity.” Others see it as growing in positive ways after a loss or trauma. Another way to think of resilience is as “bouncing forward,” which involves a willingness to let go of a past or to accept the present and to continue moving toward a fulfilling life.
There are many skills or strengths that can support resilience, such as mindfulness, creativity, adaptability, having a flexible perspective, etc. Perhaps one of the best ways to support resilience for yourself is to become more aware of your own natural strengths and to use or build upon those. There is an interesting tool called the VIA Survey of Character Strengths that can help you identify some of your own natural character strengths, which can enhance your ability to be resilient in the face of adversity. Once you become more aware of your own natural strengths, then ask yourself, “Am I allowing myself to use this strength as much as I’d like? And if not, what might I make more time for in my day?” Building on your strengths can help you to be as resilient as possible.
Here are some ways to build resilience:
- Connect with people
- Practice gratitude
- Get support if you are struggling
- Find your strengths and use them
- Make sure you get enough sleep
- Learn how to meditate
- Get outside and enjoy nature
First, invite some compassion, and patience, for yourself. Resilience is not about denying yourself the opportunity to grieve, or to feel the losses and challenges of dealing with cancer. The reality is that the stress and fatigue of treatment will get to you at times. When that happens, acknowledge it. Instead of trying to push it away, really acknowledge it. Become aware of how lousy you’re feeling and put a label to it. Perhaps even say out loud, “I feel like ____ right now!” Allow yourself to have some “down” days. And then also allow yourself to invite the possibility of resilience with each new day or each new moment by taking some small doable action that you know brings a little bit of vitality or shift in perspective in your experience.
For example, something like:
- Taking a 10-15 minute walk
- Sitting outside in nature
- Listening to your favorite music
- Talking with a friend
- Identifying three things that you feel honestly grateful for and writing them down on paper or sharing them with a loved one
Ultimately, allowing yourself to authentically acknowledge what you are feeling, instead of putting all of your energy toward struggling against those difficult feelings, will allow you more freedom to also pursue that which you really value in life. But it’s also important to acknowledge that this is sometimes easier said than done. The other key is to welcome compassion, instead of self-flagellation, when you don’t follow through as you had initially intended.
Create a Circle of Support: The Center on the Developing Child at Harvard University has found “the single most common factor for children who develop resilience is at least one stable and committed relationship with a supportive parent, caregiver, or other adult.” Creating a list of loving and stable adult family members, teachers and friends who can mentor and support your child throughout your cancer treatment can expand his or her circle of support and bolster your child’s resilience.
Communication Is Key: Giving your child the opportunity to share in the challenge you are facing by being honest with them about what is going on in an age appropriate way can reduces their fears. Find out what your child knows about your illness and follow their lead on how much they want to know, and when. Communication happens over time and preserves trust. Make sure they know that they can ask questions, either of you, or help them identify another trusted adult or mental health professional who they can speak to openly about what they are experiencing, and have their questions addressed honestly.
Timing is Everything: Allow your children the time to adjust alongside you and the rest of the family. Help them to find a safe outlet for their thoughts and feelings. Children aren’t mini-adults – they adjust and cope intermittently and may need more reassurance and “you time” than usual. You may want to form an alliance with your child’s teacher and school counselor or connect with the oncology social worker at your cancer center.
You may find the following resources helpful:
First, it’s very possible to have fear of recurrence AND to also be resilient. Being resilient doesn’t require that you “get rid of your fears.” To tell someone who is afraid to “just stop being afraid” – how well does that work? It doesn’t! In fact, sometimes we can feel stuck when we put all of our focus on the need to get rid of a particular fear or emotion.
So instead of trying to get rid of your fears, I would encourage you to move toward acceptance of the fears AND still pursue resilience. How do you do this? Acknowledge the fear(s). Sometimes it’s helpful to ask yourself, “does this fear (of recurrence) serve me? And if so, how?” Fear can be a wonderful motivator, for example, to motivate you to keep follow-up doctors’ appointments when it may be the last thing you want to do. Can you befriend that part of the fear, or even thank the part of the fear that keeps you trying to live a healthy life, following through with your medical appointments, or seeking out the doctor when a potential symptom arises?
This doesn’t mean you have to like being afraid. But would accepting those fears, instead of fighting them, allow you to put your energy and focus toward what you do want to move toward in life, instead of what you want to get rid of?
- An opening up to new possibilities and new priorities
- Improved relationships
- An enhanced appreciation of life
- A greater awareness of one’s own strengths
- A sense of spiritual growth or a strengthening of beliefs.
On average, half to three-quarters of people experiencing a significant trauma or loss, including a diagnosis of cancer, will also experience some form of post-traumatic growth. Some research shows that women, older adults and those with better social support are more likely to experience post-traumatic growth.
That said, I want to also highlight that the fact that people experience post-traumatic growth does not mean that people also don’t experience a whole range of challenging emotions, such as anger, sadness, fear, grief, etc., in the process. Sometimes the more traumatic an experience is, the more opportunity for growth it can also provide.
Dealing with change and loss is an inevitable part of life. Having a cancer diagnosis can pull the rug right out from under you and may lead you to confront your mortality, destabilize your sense of the world, and challenge your sense of self. How we perceive these stressors (as setbacks or as opportunities for growth) plays a major role in how resilient we will be during the storms of life.
Resilience is what gives you the psychological fortitude to cope with life’s stressors, hardships, grief and losses. Thankfully, resilience is a skill that can be learned, cultivated and strengthened throughout one’s lifetime.
Meditation is an excellent way to expand and strengthen your resilience. Meditation has been practiced for thousands of years and has been scientifically studied, showing many positive health impacts. Meditation is a technique that teaches you how to become fully present and aware. Regular practice can decrease anxiety and increase your ability to withstand stress.
While meditation is easy to learn it requires consistent practice to truly achieve its benefits. There are different meditation practices that you can explore, such as:
- Focused attention meditation
- Mindfulness meditation
- Reflective meditation
- Heart-centered meditation
Do you want to try out a quick meditation practice? Great! One of our favorite meditations is the Loving Kindness meditation because it helps cultivate warm feeling of love and compassion.
First, set your timer for 10 minutes. I know, 10 minutes! Don’t worry, it will go quick. Now sit in a comfortable chair or lie down if that feels more comfortable. Place your hands on your heart. You can close your eyes or keep them open. What is important is that you recognize what is right for you.
Begin to notice your breath, not forcing yourself to breathe more deeply, but rather bringing your awareness to the inhalation and exhalation. Focus on your heart. Placing your hands on your heart will help with this. Recall feelings of care, kindness and friendliness. You might find a friend, family member or pet comes to mind. Simply acknowledge these images as loving companions. After a few moments, begin to say these words:
"May I be safe
May I be happy
May I be at ease
May I be filled with loving kindness"
Reciting these lines two to three times and then returning to the breath concludes this simple but effective meditation.
For some, guided meditation or walking meditation is more accessible and feels less intimidating. The following resources can help you find the meditation practice that will work best for you:
It’s true that, unfortunately, some people have a difficult time relating to us when we express ourselves authentically. They may choose not to see or hear things that are uncomfortable to them. This in turn may encourage us to hide our struggles for fear that showing our vulnerability will make us seem weak.
It is important to know that you can authentically express your suffering and be resilient at the same time. In fact, giving yourself space to express your full range of feelings (grief, loss, anger in addition to hope, joy, and relief, etc.) is important for resilience and can help serve as a buffer to additional stress. Sometimes it’s helpful to get together with fellow patients or survivors who can help validate the ongoing challenges of survivorship that you might be experiencing. I would also encourage you to tell the truth of the range of your feelings to the people around you AND to offer them some guidance about how they can respond in a helpful way. For example, you could tell them what kind of help you need and when you need it.
Sharing our weakness, vulnerability, and fears can often lead to greater intimacy with the people that matter most. You might want to explore the work of social worker and researcher Brené Brown on the power of vulnerability. See her Ted Talk for more on this.
Great question! Research indicates that there may not be a clear-cut connection.
First let’s clarify: What is PTSD? Post-Traumatic Stress Disorder is a psychiatric condition that some people experience after exposure to an intensely traumatic experience. It is characterized by a combination of symptoms, such as re-experiencing trauma in the form of flashbacks or nightmares; avoidance; hyper-arousal, such as feeling on edge or easily startling; and altered cognition or mood, such as having problems remembering details, feeling guilty or losing interest in life; lasting at least one month. Although various aspects of a diagnosis of and treatment for cancer may be traumatic and stressful, a relatively small number of people with cancer are diagnosed with PTSD. Estimates range from roughly 2 to 20 percent.
Post-traumatic growth (PTG) on the other hand is positive psychological change resulting from struggling with a significantly stressful or traumatic event or life crisis. A traumatic event can impact the basic assumptions we make about the world, such as predictability, controllability, and our self-identity. As people struggle with creating a new reality after a highly stressful event, such as a diagnosis with cancer, this can prompt post-traumatic growth. People often experience growth in the following ways:
- Being open to new possibilities
- Positive change in relationships and sense of connection with others
- Enhanced sense of self or self-esteem
- Greater appreciation of life
- Strengthened spiritual or religious connection
Whereas a minority of people with cancer experience PTSD, a vast majority, around 70 to 90% of survivors of cancer will indicate post-traumatic growth in at least one area. The relationship between PTSD and PTG is not fully understood. Some people with cancer will experience one or the other, or even both at the same time.
According to Action for Happiness, “Recovery from major trauma, pain, or loss is a big achievement, it is difficult and takes time. It is not uncommon that some degree of change is a part of that process whether it is a change in our circumstances or how we feel about our lives. In some instances this change can be profound – a change in who we discover we are or how we focus the direction of our lives and research indicates that some people experience a significant personal growth as a result of major negative events.”
Post-traumatic growth is a process and an outcome and as the above quote suggests, is not limited by time. We do know that growth can occur even in the midst of the trauma of a cancer diagnosis. Growth begins as we recognize that life has changed as a result of cancer, as we make meaning and sense of our experience, as we deepen and strengthen our relationships, as we develop or master new skills, as we reprioritize our goals or perhaps take on new goals, and as we deepen our connection to something bigger than ourselves.
Unfortunately, resilience does not make it less likely for bad things happen. But resilience and post-traumatic growth can help us weather future adversities.