The art of being resilient: How can I thrive following spinal cord injury Dr Ashley Craig, Professor, John Walsh Centre for Rehabilitation Research, Sydney Medical School, The University of Sydney Based on work funded by the ARC, NHMRC, LTCSA and MAA 1
Senior Clinical Psychologist READ Clinic, Erina, NSW
How resilient do you think you are?
What is resilience? Something that occurs when one faces adversity It is a dynamic process It involves maintaining stable social, psychological and physical functioning A quality involving strength of purpose, hardiness, perseverance, tenacity, resoluteness, endurance True grit! Craig, A. (2012). Resilience in people with physical disabilities. In P. Kennedy (Ed.). The Oxford Handbook of Rehabilitation Psychology. Oxford: Oxford University Press, p.474-491.
Resilient behaviour is characterised by: A belief that one can self-manage Able to form close relationships Able to achieve positive outcomes in their daily lives A degree of autonomy Able to problem solve Optimistic and humorous despite adversity Able to manage stress and trauma associated with adversity Craig, A. (2012). Resilience in people with physical disabilities. In P. Kennedy (Ed.). The Oxford Handbook of Rehabilitation Psychology. Oxford: Oxford University Press, p.474-491. Rees, R. (2012). Resilience of people with traumatic brain injury and their carers. InPsych, April, 12-13.
Improved adjustment adaptive adjustment maladaptive Poor adjustment time since injury Middleton, J., & Craig, A. (2008). Psychological challenges in treating persons with spinal cord injury. In A. Craig and Y. Tran (Eds.). Psychological dynamics associated with spinal cord injury rehabilitation: New directions and best evidence. New York: Nova Science Publishers
No one doubts that catastrophic injury is associated with serious challenges and difficulty!!
However, there are ways of boosting one s resilience after a catastrophic injury like SCI
How does one do that?
You may ask the question whether I have the right or the ability to be giving advice on this topic?
Research evidence provides clues about ways one can enhance one s resilience
Based on good evidence, the foundations of resilience are: 1. Depending on your capacity, exercise regularly 2. Eat a healthy diet 3. Work on your sleep so you get at least 6 hours per night 4. Work on your social support networks 5. Engage in frequent enjoyable activities
Resilience is strongly related to expectations, something we call selfefficacy
Self-efficacy has been defined as the belief in one s capabilities to organize and execute the courses of action required to produce given attainments (Bandura, 1997) If I have high self-efficacy, then this means I perceive/ believe I can manage my behaviour and daily outcomes
If I have poor self-efficacy, it can be damaging physically and mentally
An abuse of self-efficacy
The mediating role of self-efficacy?
QOL SF-36 Middleton, Craig & Tran (2007). Archives Physical Medicine Rehabilitation, 88, 1643-1648 90 80 70 Those with high selfefficacy different to Australian norms in three physical domains 60 50 40 30 20 phys fn phys role pain health vitality social fn emot fn mental health Aust norms low SE SCI High SE SCI
QOL SF-36 Source: Middleton, Craig & Tran (2007). Archives Physical Medicine Rehabilitation, 88, 1643-1648 90 80 70 60 50 40 30 20 phys fn phys role pain health vitality social fn emot fn mental health Aust norms low SE SCI High SE SCI Those with low selfefficacy different to the other two groups in all domains p<.05
Chronic pain influences mood (and mood influences pain) (Greater time since injury associated with lower pain) TIME SINCE INJURY -0.31 DEPRESSIVE CHRONIC PAIN 0.50 MOOD Craig, A., Tran, Y., Siddall, P., Wijesuriya, N., Lovas, L., Bartrop, R., & Middleton, J. (2013). Developing a model of associations between chronic pain, depressive mood, chronic fatigue and self-efficacy in people with spinal cord injury. The Journal of Pain, 14, 911-920.
Self-efficacy mediates/ buffers this effect of pain on mood -0.54 SELF-EFFICACY -0.47 TIME SINCE INJURY -0.31 CHRONIC PAIN 0.32 DEPRESSIVE MOOD Craig, A., Tran, Y., Siddall, P., Wijesuriya, N., Lovas, L., Bartrop, R., & Middleton, J. (2013). Developing a model of associations between chronic pain, depressive mood, chronic fatigue and self-efficacy in people with spinal cord injury. The Journal of Pain, 14, 911-920.
However, self-efficacy has no influence on fatigue Chronic pain and depressive mood related to higher fatigue (and vice versa) -0.54 SELF-EFFICACY -0.47 TIME SINCE INJURY -0.31 CHRONIC PAIN 0.32 DEPRESSIVE MOOD 0.52 FATIGUE 0.40 Craig, A., Tran, Y., Siddall, P., Wijesuriya, N., Lovas, L., Bartrop, R., & Middleton, J. (2013). Developing a model of associations between chronic pain, depressive mood, chronic fatigue and self-efficacy in people with spinal cord injury. The Journal of Pain, 14, 911-920.
Self-efficacy plays a protective role, and will be most effective when one correctly interprets the relationship between one s behaviour and outcomes Unfortunately, not everything you believe or think is correct We can all be deluded (some more than others of course!!) It will be helpful to be aware that our thoughts/ expectations can be incorrect
Persistent anger and irritability will lower resilience
Thinking in a negative, catastrophic, unhelpful manner will lower resilience while.. thinking optimistically, realistically, and helpfully about adversity enhances resilience
Whatever strategy or treatment used, resilience will be substantially enhanced if it becomes clear to the person that that what they are doing is successful or adaptive. A powerful self-statement: I have done it before, I can do it again.
CBT can enhance resilience
Pain intensity Clinical trial outcome for adults with SCI. Chronic pain (0=none, 2= discomfort, 3=distressing) following group CBT. Control SCI participants received usual rehabilitation care Craig, A. (2008). Short and long-term outcomes following cognitive behaviour therapy for people with SCI. In A. Craig and Y. Tran (Eds.). Psychological dynamics associated with spinal cord injury rehabilitation: New directions and best evidence. New York: Nova Science Publishers.
Clinical trial outcome for adults with SCI. Depressive mood (Beck Depression Inventory where high scores indicate high depressive mood) following group CBT. Control SCI participants received usual rehabilitation care Craig, A. (2008). Short and long-term outcomes following cognitive behaviour therapy for people with SCI. In A. Craig and Y. Tran (Eds.). Psychological dynamics associated with spinal cord injury rehabilitation: New directions and best evidence. New York: Nova Science Publishers.
Clinical trial outcome for adults with SCI. Perceived control (perceptions of helplessness where high scores indicate helplessness) following group CBT. Control SCI participants received usual rehabilitation care Craig, A. (2008). Short and long-term outcomes following cognitive behaviour therapy for people with SCI. In A. Craig and Y. Tran (Eds.). Psychological dynamics associated with spinal cord injury rehabilitation: New directions and best evidence. New York: Nova Science Publishers.
Thank you