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Aurbach: Recalibrating Resilience, Part 1

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Editor's note: This is the first of a three-part series on resilience. The second and third parts will post on Wednesday and Thursday.

Robert Aurbach

Robert Aurbach

William had multiple flags for poor outcomes, and Margaret, his claims manager, noticed that every time there was the least hiccup in the progress of his claim William seemed to fall apart and need extra attention to calm him down. Margaret suggested that William take a "resilience" course, and William reluctantly agreed. The course attempted to show William techniques from a well-known "positive psychology" approach to resilience. William stopped listening to the lecture halfway through — he later told his friends that it was too "touchy-freely."

After a particularly tough week, one of Margaret's co-workers noted that she was acting particularly stressed. Margaret was a bit hostile to some of her claimants and was heard muttering, "Why can't they just get on with their lives like I do?" Margaret had heard about a resilience-building practice that was offered through work. It featured a “mindfulness” meditation practice. She signed up for a class and tried to fit the technique she learned into her daily routine. But she had always been a busy person, and housework, her kids and her husband took up all the energy she had after work. She had precious little "me time" anyway, and making time for meditation just didn't happen.

The problem with both Margaret and William isn't that they were given bad advice. They were just given advice that wasn't sufficiently specific to their personalities and situations. Because it was too general, it didn't become enough of their lives to make it real and useful. A new understanding of what resilience is and how it actually works to help people "bounce back" from adversity recognizes that "one-size-fits-all" doesn't work for many people. What is needed is a better understanding of how to use the mind's reaction to challenges in an individualized way.

What's wrong with 'resilience?'

It seems pretty obvious that we’d all be better off if we were a little more personally resilient. It would be great for injured workers. They'd be less likely to be adversely affected by their experience of the compensation system and less likely to suffer secondary psychological impacts from their injury. Resilient people who suffer an injury are less likely to miss work, less likely to have time off from injury, less likely to believe someone else was at fault in the accident, more likely to recover and return to work quickly, and more emotionally and physically able to cope with the return-to-work process.

It'd be great for claims staff, too. Sometimes we forget what a difficult job claims adjusting is, and take high absence and turnover rates, presenteeism and burnout as necessary evils. A more resilient claims staff is more engaged and productive, less likely to be adversely affected by the work and more likely to treat claimants appropriately.

The trouble is that "resilience" has been elusive in at least two ways. First, it's a characteristic that isn't generally well described, except by its effects. We know what resilience does, but we have no description of how resilience works. Without a definition of what resilience is, the phenomenon is in a "black box" that is not helpful for making use of the concept.

Second, the advice given regarding resilience suffers from circularity, generality and difficulty in application. Common advice like, "If you want to be more resilient, be more optimistic" sounds a little too much like "If you want to be wealthy, just get more money." It's not very helpful. Of course we'll be able to bounce back from things better if we're optimistic. The conundrum is how someone becomes more optimistic, especially when she is stressed by being in the middle of recovery from an injury.

Back in the 1980s and 1990s researchers in child development appropriated the term "resilience" from materials science to describe the phenomenon of vulnerable children from disadvantaged environments who somehow managed to thrive and succeed. Lots of correlation studies were done to discover traits that appeared most frequently in that population. Correlation studies are useful for looking at a whole population, but not particularly helpful in understanding the impact on individuals. For instance, we know that smoking is correlated with increased incidence of certain diseases, but that information doesn't tell us what health impacts an individual smoker will have. Notwithstanding this limitation, the correlation studies became the source of advice for individuals. Naturally enough, many people didn't feel as though they "fit" the resilience advice they were being given, and resilience training has been inconsistent in its uptake.

Where there is a promise of a silver bullet, a cottage industry will usually develop. Several programs have been developed and sold as "resilience training." They may be supported by research that shows that, among those who participated in the study and did what they were told, good things happened. For example, we're told that mindfulness meditation will improve resilience, and that's correct for those who practice it and make it part of their lives. The trouble is that the research doesn't measure the results on those people for whom mindfulness meditation is not something that they are willing to consistently practice. Those resistant people aren't studied, or don't enter or stay in the research program, and are therefore excluded from consideration in the reporting of results. The studies only show that the technique works for the people who are willing to devote themselves to the approach, and is silent with regard to the rest of us. And a quick survey of people around you will show that some people like the idea and will try it, some people (like William) think it’s “not for them,” and some people (like Margaret) simply won’t make the time for consistent practice.

The same is true with numerous other programs. The positive psychology movement has its resilience program, and it works just fine — for those to whom positive psychology is a comfortable way to look at the world. The rest of us are likely to be turned off and, if we try it at all, fail to incorporate the practice into our ongoing "resilience toolbox." There's a good reason for this. We aren't all the same, and the skills of resilient people aren't all the same. One-size-fits-all approaches to resilience are inherently flawed, not because they are wrong, but rather because they are not suitable for everyone. Approaches that "go against the grain" will not be practiced enough to become the engrained and automatic responses to distress that build personal resilience in the real world.

What we need is a more personalized approach to resilience. Most of us have some resilience skills, and William and Margaret are no exception. Sometimes those skills aren’t enough to insulate us from difficulty. The key is to build up "fallback" skills in our toolbox so that we have something to try when the usual strategy isn't working. To do that, we have to assess what skills we have and what other skills might fit in with the way we look at the world. Then we can pick a resilience skill that suits us to try to further develop.

Resilience skill development can be utilized in many ways. It could be an intervention for flagged workers like William, with the aim of preventing secondary psychological overlay on the original injury that may turn it into an expensive long-term claim. If William has more skills in his resilience toolbox, he's less likely to be overwhelmed by the process, and less likely to become long-term disabled.

Because the experience of processes in workers' compensation systems is highly stressful for claims managers as well, it could be used as a prophylactic intervention to minimize burnout, turnover and presenteeism. Moreover, when Margaret is less stressed, she's less likely to "inflict" her notions of what someone "ought" to do on the injured workers in her portfolio.   She will be better able to appreciate the idea that different workers have different resilience skills and different ways of coping in the world. She will be more effective because she will be better able to take each claimant as she finds them and respond appropriately.
The process of building resilience skills is just like building any other skill, and we do it according to principles that have become better understood as the understanding of the mind has advanced.

Next time

In Part 2 we’ll talk about how people under stress process information, and learn how we can use the latest discoveries from brain science to develop an entirely new understanding of what resilience is and how it works. Armed with that information, we can discover the technique of creating individual approaches to building resilience that are uniquely suited to individuals. This will allow us to build and maintain our own “resilience toolbox” and to help others to do the same.

Robert Aurbach is owner of Uncommon Approach, a consulting firm, and former chief legal officer for the New Mexico Workers' Compensation Administration.

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