Motivation and emotion/Book/2020/Psychological resilience during COVID-19 pandemic isolation

Psychological resilience during COVID-19 pandemic isolation:
How can people be psychologically resilient during COVID-19 pandemic isolation?

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Overview

Figure 1. Physical representation of resilience.

Psychological resilience is what allows people to persevere through difficult events (see Figure 1). It explains why some people may be overwhelmed by an event that others shrug off. There is no shortage of stressors in life, that range from daily hassles to traumatic events. Bonanno & Mancini (2008) recognised that most people experience at least one potentially traumatic event in their life. The term "potentially" is significant, as it emphasises that people choose how they interpret and respond to such events.

Being resilient in the face of adversity has become especially relevant during the COVID-19 pandemic. A pandemic is a world-wide phenomenon that has radically changed the day-to-day lives of billions. For the first time people have had to abide by social distancing and self-isolation rules (Hall, Laddu, Phillips, Lavie, & Arena, 2020). For many, these enforced practices are a life trauma that will have lasting and adverse effects. It becomes a personal struggle for each individual to accept, adjust and endure these events. The question of growth and overcoming or sufferance and lasting harm underlies this study. Naturally some will do better than others. As evidence and examples of resilience emerge, we are given the opportunity to study these behaviours and learn what might distinguish the resilient individual from those who fair less well.

Theories of resilience

At its core resilience is found in the relationship between positive adaption to environmental stressors. One conceptualisation of resilience is as a personal trait. The emphasis of this model is on the intrinsic capability and capacities of the individual. We may therefore define ‘traits’ as a collection of characteristics or protective factors that influence how an individual perceives and responds to adversity (Luthar et al., 2000). Many protective factors have been identified. Some of the more common include: self-efficacy, optimism, conscientiousness, extraversion, and positive emotions.

While there is an emphasis here on the innate capacities of the individual, personality traits are not fixed. They are constantly developed and strengthened through the individual’s ongoing interaction with their environment (Shiner & Masten. 2012). Indeed, Shiner & Masten (2012) found that children's personality traits are an important predictor of resilience in adulthood. This was the case in individuals who as experienced low levels of adversity during developmental years. And it was equally the case for those who faced higher levels of adversity. For example, highly conscientious kids were found to grow into more resilient adults.

Even though traits are relatively fixed there is some potential for them to change over time (Shiner & Masten, 2012). This change and evolution can occur as a result of commonly occurring environmental factors or directly through conscious intervention. Meaning a child with maladaptive traits will not inevitably develop into a vulnerable adult. It is evident that traits can provide a workable and predictive model of resilience. However, traits are relatively fixed and the individual’s later capacity for resilience can align with childhood character traits or can diverge away from those traits as a result of interventions and environmental conditioning. We must therefore conclude that character traits are not the best model we have for predicting resilience in the adult individual.

The literature on resilience is filled with mini-theories that have emerged from studies of specific groups such as health care workers, police officers and adolescents. The outcome of this approach is that that few established theories have emerged that can be applied unchanged across different groups and contexts. In the literature review provided in Fletcher & Sarkar, (2013) we see that Richardson, (2002) has attempted to create a general theory of resilience and resiliency that is designed to be applicable across different types of stressors, situations, individuals, and communities. In Richardson’s theory a person begins within a homeostatic state or ‘comfort zone’ where they feel balanced physically, mentally and spiritually (Richardson, 2002). People are disruption from there homeostatic state when a stressor arises in their environment for which they have no management strategy or defence (Richardson, 2002). After repeated exposures to the stressor and disruption, the subject will return to either their old state or they will establish a new homeostatic state. This reintegration response will take place through one of four options:

1.      Resilient reintegration.

This represents a positive adaption over adversity. In this case a person returns to a new and ‘higher’ homeostatic state. The subject can be said to have grown and developed through the identification and development of novel resilient qualities.

2.      Homeostatic reintegration.

In this instance the person endures and manages to ‘just to get past’ the adversity. They return to their original state. This strategy allows people, who are strongly attached to their comfort zone, to overcome adversity but at a cost. They fail to recognise the growth opportunities presented out of fear that they will invite further adversity.

3.      Reintegration with loss

This represents a negative adaption over adversity. In this case a person losses resilience capacity in the encounter with the stress event and returns to a lower homeostatic state.

4.      Dysfunctional reintegration

This is again a negative adaption over adversity where people return to past destructive behaviours like drug abuse.

One limitation with Richardson’s model is it theories a person’s experience with a single event. In practice people may face multiple adversities and reintegration processes within single period of time. Richardson’s model does not account for the compounding effects of multiple adversities.

The secondary impacts of COVID-19

The are numerous stressors that have arisen during the pandemic that have increased feelings of stress (Shanahan et al., 2020).  Both before and during the during COVID-19 emotional distress seems to be the main predictor of stress. Yet, since the pandemic lifestyle and economic disruptions have also become common sources of stress (Shanahan et al., 2020). This makes sense as most peoples day to day life have been affected at some level. Such a large change that affects the whole population is inevitably going to disrupt peoples ‘homeostatic state’. The feelings associated with these new sources of stress include uncertainty, ambiguity, loss of control and concern for self and others (Shanahan et al., 2020). Even though directly COVID-19 poses a low risk to most adults. People seem to be significantly stressed by the secondary consequences like lock downs and economic decline. Which makes sense, given aspects like economic decline likely pose a bigger threat to most adults then the virus. Furthermore, economic downturns are associated with declining mental health, and seem to alter people’s perspective on their future careers (Gassman‐Pines, Gibson‐Davis & Ananat, 2015). Overall people feel uncertain and are stressed about the pandemic and how it affects them economically and socially. These new stressors have not only induced stress but increased risk of mental illness.

Declining mental health

COVID-19 poses a serious threat to mental health. Symptoms of anxiety and depression along with suicide rates have all increased since the pandemic began (Xiong et al., 2020). Overall, these symptoms range from mild to severe and vary across populations. The most severe symptoms were seen in those communities affected by mandatory quarantine, job loss, and amongst those individuals who had vulnerable loved ones (Xiong et al., 2020). As a result of these precautionary health measures, people have spent more time alone and have experienced overall reduced freedom in their day to day lives. These drastic changes present a range of specific stressors that have created a critical mental health burden for governments to respond to and people to deal with:

The impact on some groups is likely to be amplified within those groups that, prior to the pandemic, were already seen as ‘high risk’ in relation to the adverse effects of stress. For example, gender is a well-established determinant of psychological stress.  It is common in psychological literature to report women as having consistently higher prevalence rates of both anxiety and depressive disorders (McLean et al., 2011). Another vulnerable group are those who have a history of emotional distress and or mental illness (Shanahan et al., 2020). Prior to the pandemic we might therefore suppose that some groups that are currently identified as vulnerable, might not be only because of the virus. But rather those groups were also vulnerable to negative mental health outcomes prior to the pandemic. Since then, common stressors like social exclusion and victimisation have become exacerbated during the lockdowns (Shanahan et al., 2020). These groups that were at high risk prior to the pandemic could well be expected to be made even more vulnerable as a result.

Interesting note on loneliness

As with physical inactivity, loneliness is another highly prevalent health concern that is thought to have worsened during the COVID-19 pandemic. Loneliness is defined as the experience of lack of connection with others (Killgore et al., 2020). Feeling lonely increases your risk of death, along with an increased risk of developing various serious mental and physical illnesses (Killgore et al., 2020). It is likely to be a major source of stress in those who have been cut off from community and family by the pandemic. It is perhaps surprising that the rates of loneliness have remained largely unchanged during COVID-19 (Luchetti et al., 2020). A similar study compared the prevalence of loneliness during April 2018 and 2020 and came to a similar conclusion (McGinty et al., 2020). This finding is contrary to the popular belief that social distancing and isolation orders necessarily leads to an increase in loneliness. In the Luchetti et al (2020) study sample, older adults were the only group that showed a slight increase in loneliness. This increase disappeared as social distancing rules were hardened into enforced isolation and stay at home orders. In fact, people have reported that they experienced an increase in social support since the advent of COVID-19 (Luchetti et al., 2020). This seems contradictory, however it is likely explained when we factor in the vigorous community response to COVID-19 and the nature of loneliness. Luchetti et al (2020) highlights a phenomenon where people can feel lonely in a crowd and feel content and connected while alone. This implies that a persons feeling of connection is a far better indication of loneliness than number of their social contacts. Even though people may be spending more time alone during COVID-19, they perceive connection to community that were not previously aware of. People readily report feeling part of a community wide effort to slow the spread of the virus (Luchetti et al., 2020). These findings show that individuals, families and communities feel emotionally connected despite the facts of physical distancing and restrictions on social gatherings. This increase in perceived support has likely protected against any potential confounding effects COVID-19 might otherwise have had on loneliness. We might therefore conclude that people would have likely experience more loneliness if it wasn’t for the sense of community involvement and collective action that has been undertaken in order to prevent the spread of the virus.

Physical inactivity

Physical inactivity has been a serious health issue prior to COVID-19 and has worsened since. In Australia 83% of adults do not meet the recommended PA guidelines (National Health Survey: First results, 2017-18,). This is important as physical inactivity has a similar health burden to smoking and obesity and it is estimated to be responsible for 9% of premature deaths globally (Lee et al., 2012). There is an abundance of anecdotal and statistical evidence that COVID-19 has caused active people to become less so. Meyer et al., (2020) found an average 32% decrease in those who were previously meeting the PA guidelines. However, there was no significant change in PA for people who were not active prior to COVID-19. That is perhaps not surprising. Where PA levels are already low, there is likely not much room for them to decrease further. It is also highly unlikely the pandemic would encourage previously inactive people to undertake more exercise than usual.

It is clear from these results that even if PA levels were unaffected by COVID-19, there is a huge need for people to become more active. However, there is now evidence that shows COVID-19 is likely causing people to exercise less. It is important to change these behaviours not only to improve physical health but also to improve mental health. PA is a proven and effective buffer against psychological stress. PA is known to make people more resilient (Meyer et al., 2020). Hence, it clearly a useful tool that can help individuals negotiate a pathway through the pandemic that leaves them strong, resilient and able to resume normal living.

Suggestions to develop resilience

Physical activity

It is well established that attempting to address maladaptive thought patterns directly can often be difficult and make things worse. One if the benefits of PA is that people can reduce depressive and anxious symptoms, without risk, simply by exercising (Harvey et al., 2018). In fact, Harvey et al (2018) reports that 12% of new depression cases could be prevented if people exercised for just one hour per week. However, and as previously mentioned, most people are not physically active, a fact that COVID-19 has only made worse. This suggests that exercise is useful as a treatment and prevention of depression. PA can also be applied alongside other behavioural and cognitive treatments to enhance resilience. PA has been positively correlated with higher resilience in COVID-19 isolation (Carriedo et al., 2020). PA has helped to improve emotional regulation and reduce maladaptive coping strategies.

A well know maladaptive coping mechanism is ruminating over issues. PA can offset the negative effects of rumination.  Physical activity (PA) fosters psychological resilience by increasing people’s tolerance to stress. This is more than an improvement in mood, but rather a change in how people appraise and respond to issues (Bernstein & McNally, 2018). Bernstein & McNally (2018) found that people who exercise regularly tend to spend less time ruminating and become less consumed by their issues. This suggests that PA causes bouts of worry to be shorter in duration and less severe than it otherwise would be.  Furthermore, participants also reported ruminating less frequently, even though no difference was evident (Bernstein & McNally, 2018). Perhaps this discrepancy is explained by ruminations overall diminished impact. As a result, issues likely hold less significance in people minds. Those who exercise regularly are likely better able to forget about distressing issues sooner than their non-active counterparts. Overall exercise seems to increase peoples stress tolerance by reducing the duration, severity, and impact of rumination and worry.

Emotional flexibility

Emotional flexibility is correlated with high resilience and is another strategy resilient people deploy to adapt to difficult situations. This points to popular notion that resilient people remaining optimistic in negative situations. Emotional flexibility is when someone displays the appropriate emotional response given a situations context (Waugh et al., 2011). For example, during COVID-19 people might feel uncertain about their employment or concerned for their loved ones. However, if this same situation is likely to continue for the foreseeable future, it might no longer be useful to continue feeling uncertain or concerned. A resilient person is one who can fully engage in these changing situations for an appropriate duration context (Waugh et al., 2011).  This allows the individual to face and experience the essential emotions without negative emotions becoming chronic (Waugh et al., 2011). People who show greater flexibility in their emotional regulation are more resilient and hence more likely to positively adapt.

Social support

As previously mentioned COVID-19 has not made people feel lonelier. However, cultivating social support is still a well-established strategy for becoming more resilient. Social support is the feeling of being connected with others (McCanlies, Gu, Andrew & Violanti, 2018).  Having access to supportive social networks is related to positive mental health outcomes. That is less likely to experience negative affect and more likely to have positive emotions. Furthermore, social support has been associated with resilience and decreasing symptoms of depression (McCanlies, Gu, Andrew & Violanti, 2018). It accomplishes this through several psychological and physical mechanisms including feeling understood, positive appraisal of events and improved self-efficacy. Furthermore, communities have been shown to foster individual members resilience. It seems that community members are closely affected by each other’s coping strategies. This clear during the COVID-19 pandemic where the community has taken significant steps to prepare for and manage stressors in the environment (Luchetti et al., 2020). This is also apparent in other crisis where individuals who belong to a community prior to adversity. Tend to show far better outcomes after than their alone counterparts (Southwick, Sippel, Krystal, Charney, Mayes & Pietrzak, 2016).

Conclusion

There a number of ways psychological resilience can be developed during COVID-19 isolation. Richardson’s theory of resiliency states that we must develop appropriate mechanisms to deal with stress to positively adapt to adversity. The mechanisms focused on in this chapter include physical activity. Which is a healthy behaviour that indirectly makes people more resilient by reducing the severity and impact of negative thought patterns like rumination, negative affect, and depressive symptoms. The second mechanism is emotional flexibility, which encourages people to experience the appropriate emotions considering the context. This is especially relevant during COVID-19 as the difficult environment validates people’s right to feel negative emotions. Yet by being emotionally flexible, individuals will be able to find hope and resilience in the community response to COVID-19. During periods of isolation and social distancing, surprisingly people have not become lonelier. This is largely due to the increased social support that has been perceived during the community’s response to COVID-19. Increased social support results in more positive emotions and less negative ones. Meaning individuals with greater perceived levels of social support are less likely to develop depression and other negative mental health outcomes. In turn making them more resilient during isolation. Overall the three mechanisms mentioned here PA, emotional flexibility and social support are each effective factors to cultivate during COVID-19 to become more resilient.

See also

Loneliness (Wikipedia)

Psychological resilience development in children (Book chapter, 2017)

Psychological resilience (Book chapter, 2011)

References

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Bonanno, G., & Mancini, A. (2008). The Human Capacity to Thrive in the Face of Potential Trauma. PEDIATRICS, 121(2), 369-375. https://doi.org/10.1542/peds.2007-1648

Carriedo, A., Cecchini, J., Fernández-Río, J., & Méndez-Giménez, A. (2020). Resilience and physical activity in people under home isolation due to COVID-19: A preliminary evaluation. Mental Health And Physical Activity, 19, 100361. https://doi.org/10.1016/j.mhpa.2020.100361

Fletcher, D., & Sarkar, M. (2013). Psychological Resilience. European Psychologist, 18(1), 12-23. https://doi.org/10.1027/1016-9040/a000124

Gassman‐Pines, A., Gibson‐Davis, C. M., & Ananat, E. O. (2015). How economic downturns affect children's development: an interdisciplinary perspective on pathways of influence. Child Development Perspectives, 9(4), 233-238.

Harvey, S., Øverland, S., Hatch, S., Wessely, S., Mykletun, A., & Hotopf, M. (2018). Exercise and the Prevention of Depression: Results of the HUNT Cohort Study. American Journal Of Psychiatry, 175(1), 28-36. https://doi.org/10.1176/appi.ajp.2017.16111223

Killgore, W., Cloonan, S., Taylor, E., & Dailey, N. (2020). Loneliness: A signature mental health concern in the era of COVID-19. Psychiatry Research, 290, 113117. https://doi.org/10.1016/j.psychres.2020.113117

Lee, I., Shiroma, E., Lobelo, F., Puska, P., Blair, S., & Katzmarzyk, P. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The Lancet, 380(9838), 219-229. https://doi.org/10.1016/s0140-6736(12)61031-9

Luchetti, M., Lee, J., Aschwanden, D., Sesker, A., Strickhouser, J., Terracciano, A., & Sutin, A. (2020). The trajectory of loneliness in response to COVID-19. American Psychologist, 75(7), 897-908. https://doi.org/10.1037/amp0000690

Luthar, S., Cicchetti, D., & Becker, B. (2000). The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work. Child Development, 71(3), 543-562. https://doi.org/10.1111/1467-8624.00164

McCanlies, E. C., Gu, J. K., Andrew, M. E., & Violanti, J. M. (2018). The effect of social support, gratitude, resilience and satisfaction with life on depressive symptoms among police officers following Hurricane Katrina. International journal of social psychiatry, 64(1), 63-72.

McGinty, E., Presskreischer, R., Han, H., & Barry, C. (2020). Psychological Distress and Loneliness Reported by US Adults in 2018 and April 2020. JAMA, 324(1), 93. https://doi.org/10.1001/jama.2020.9740

McLean, C., Asnaani, A., Litz, B., & Hofmann, S. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal Of Psychiatric Research, 45(8), 1027-1035. https://doi.org/10.1016/j.jpsychires.2011.03.006

Meyer, J., McDowell, C., Lansing, J., Brower, C., Smith, L., Tully, M., & Herring, M. (2020). Changes in Physical Activity and Sedentary Behavior in Response to COVID-19 and Their Associations with Mental Health in 3052 US Adults. International Journal Of Environmental Research And Public Health, 17(18), 6469. https://doi.org/10.3390/ijerph17186469

National Health Survey: First results, 2017-18. Australian Bureau of Statistics. (2018). Retrieved 13 October 2020, from https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release#data-download.

Richardson, G. (2002). The metatheory of resilience and resiliency. Journal Of Clinical Psychology, 58(3), 307-321. https://doi.org/10.1002/jclp.10020

Shanahan, L., Steinhoff, A., Bechtiger, L., Murray, A. L., Nivette, A., Hepp, U., ... & Eisner, M. (2020). Emotional distress in young adults during the COVID-19 pandemic: Evidence of risk and resilience from a longitudinal cohort study. Psychological medicine, 1-10.

Shiner, R., & Masten, A. (2012). Childhood personality as a harbinger of competence and resilience in adulthood. Development And Psychopathology, 24(2), 507-528. https://doi.org/10.1017/s0954579412000120

Southwick, S. M., Sippel, L., Krystal, J., Charney, D., Mayes, L., & Pietrzak, R. (2016). Why are some individuals more resilient than others: the role of social support. World Psychiatry, 15(1), 77.

Waugh, C., Thompson, R., & Gotlib, I. (2011). Flexible emotional responsiveness in trait resilience. Emotion, 11(5), 1059-1067. https://doi.org/10.1037/a0021786

Xiong, J., Lipsitz, O., Nasri, F., Lui, L., Gill, H., & Phan, L. et al. (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal Of Affective Disorders, 277, 55-64. https://doi.org/10.1016/j.jad.2020.08.001

External links

COVID-19 Dashboard (World Health Organisation)

TED Talk: The threes secrets of resilient people - Lucy Hone