Tigger. That orange-furred, black-striped, tiger character originally introduced in A. A. Milne’s book The House at Pooh Corner. Tigger is a very bouncy fella. Tigger is amongst the most exuberant creatures in the 100 Acre Wood, and his most stand out and well-known feature is his very springy tail. Tigger has resilience.
The wonderful thing about Tiggers…..Is Tiggers are wonderful things…..Their tops are made out of rubber…..The bottoms are made out of springs…..They’re bouncy, trouncy, flouncy, pouncy…..Fun, fun, fun, fun, fun…..But the most wonderful thing about Tiggers is…..I’m the only one…..The wonderful thing about Tiggers…..Is Tiggers are wonderful chaps…..They’re loaded with vim and vigor…..They love to leap in your laps…..They’re jumpy, bumpy, clumpy, thumpy…..Fun, fun, fun, fun, fun…..But the most wonderful thing about Tiggers is…..I’m the only one…..Tiggers are cuddly fellows…..Tiggers are awfully sweet…..Everyone else is jealous….. That’s why I repeat…..The wonderful thing about Tiggers…..Is Tiggers are wonderful things…..Grrrrrrrrrrrrr ! ! ! !
While Tiggers are not always comfortable to have around, Tigger does represent that fabulous ‘bounce-back’ that means he just goes on without being one bit phased by things that happen in the 100 Acre Wood. Resilience is all about ‘bounce-back’ – being able to carry on despite adversity.
How do we help the people we work with develop this resilience? Because for so many people I see, their bounce-back has gone rather flat. They present as ‘demoralised’, and for some, even ‘defeated’ – their sense of loss is so huge that they don’t know who they are any more, don’t have a sense of what they have to offer anyone, and see themselves as pawns in an enormous chess game of life. Some don’t even see themselves as pawns anymore – more like a piece of the chess board. And this can happen even after completing a pain management programme – it can be a big part of relapse, or returning to unhelpful ways of coping.
Resilience as a construct has been a fruitful area of research in many areas of psychology. What makes one person live well despite challenges, and another to crumple? It’s the subject of my research – how do people who live well despite their pain actually do so?
Some of the things that have been shown to help are:
- Having access to effective social support. A network of friends or people with whom the person can talk about what is going on, people who can help with practical tasks, and people who accept the person who has pain without judging them.
- The ability to recognise that negative emotions don’t last forever. That these emotions ebb and flow and, given time and patience, even really bad feelings will pass. (just try being angry at the same intensity for more than an hour!)
- The ability to accept that negative feelings are able to provide us with helpful information about what is occurring – but that we don’t necessarily have to ACT on that emotion. Emotions like sadness at the loss of abilities or function can tell us how important they were to us. Anger can tell us that maybe someone is metaphorically standing on our toes. Anxiety or fear can tell us what we really value.
- and finally, being able to soothe and nurture ourselves during periods of negative emotion. This can be self-soothing, or it can be about obtaining encouragement or nurturing from others.
We can also help people develop both an awareness of the factors that are likely to trip them up and move them towards a set-back where new plans and skills fail to be used, and to plan for these episodes so that they have skills to ‘pick themselves up, dust themselves off and start all over again’.
Turk & Winter describe this well in their self management book written for patients “The pain survival guide: How to reclaim your life” (2006). As they put it: “For chronic pain, we have seen that changes may be necessary in just about every area of life–your daily activity and rest habits, the way you choose to think about your pain, and the way you relate to others, to name only a few. In this lesson, we stress maintenance, which is the last step in the pain management program. We review the three most important pain management principles: bringing more physical activity or exercise into your life, ensuring sufficient relaxation, and bringing more diversion and fun into life.”
Marlatt and Gordon’s Cognitive-Behavioral Model of relapse prevention identifies several common factors that are linked to lapses in using new skills. Some common to people learning self management for chronic pain are – changes in routine, change in symptoms (either a flare-up, or a period of lower pain), changes to emotions (particularly negative emotions), the influence of ‘high risk situations’ where decisions made at the time don’t seem to be all that important but lead down a path of short-term gain but risk of long-term difficulties, and social influences. By pre-planning strategies to ‘pick themselves up, dust themselves off and start all over again’, come of the negative emotion can be reduced. Here’s a worksheet I developed some time ago showing one way of working through this with someone.
What can we contribute to helping people develop resilience? All of these things above can help – is there anything else you’d add? Just add your thoughts below in the comments section.
Turk, Dennis C; Winter, Frits. (2006). The Importance of Maintenance and “Setbacks”.The pain survival guide: How to reclaim your life. (pp. 171-183). 203 pp. Washington, DC, US: American Psychological Association; US.
BERKING, M., WUPPERMAN, P., REICHARDT, A., PEJIC, T., DIPPEL, A., & ZNOJ, H. (2008). Emotion-regulation skills as a treatment target in psychotherapy☆ Behaviour Research and Therapy DOI: 10.1016/j.brat.2008.08.005