Building Resilience— Helping Patients

to Strengthen their Mental Health

.James L. Griffith, M.D
Leon M. Yochelson Professor and Chair
Dept. of Psychiatry and Behavioral Sciences
The George Washington University
 How Do You Help a Patient
?To Become More Resilient

Being resilient means facing, moving

forward, engaging with problems
and adversities,
,Not avoiding, backing away
.or submitting to them
 How Do You Help a Patient
?To Become More Resilient
Three strategies— Which best fits your patient
?and your treatment setting
Discern what is your patient’s best strength for •
.coping, based upon past encounters with adversities
Help your patient to practice one of the empirically •
.validated resilience factors
Help your patient to utilize methods for •
strengthening emotion regulation, such as
.mindfulness or spiritual practices
 A Demoralized Elderly Man with Diabetes,
Renal Failure, and BK Amputation
A 71 year old patient has suffered for 2 decades
with diabetes mellitus complications, including
retinal deterioration and renal failure requiring
dialysis. For the past 2 years, he has been too
disabled to continue working as a cook. He is
currently recovering slowly from a below-the-knee
amputation. His doctor worries that he has
become careless in monitoring his blood glucose
.—he seems to have given up
 What Is the Patient’s Best Strength
?for Coping with Adversities

What hard challenges have you faced in the •

past? What carried you through? What kept
?you from giving up during hard times

Use patient’s responses to these questions to[

identify strengths that can be brought to bear on his
]current adversities
 What Is the Patient’s Signature
?Strength for Coping with Adversities

What year of your adult life was your best •

year? How old were you when you were at
?your best
Learn what made him good at his work. Learn what[
were his favorite music or sports at that age. What
made it a special year? From this information, try to
discern what is his most effective method for coping
].with stress. Apply this to his current situation
Practice an Empirically-Validated
Resilience Factor
Utilizing a model or mentor )1(
Optimism )2(
Humor )3(
Moral Compass )4(
Social Support )5(
Altruism )6(
 Practice an Empirically-Validated
Resilience Factor
Assertively facing obstacles )7(
Facing Fear )8(
Training )9(
Growth through encounters with adversity )10(
Meaning and Purpose )11(

:For detailed discussion, see

Catapano L, Griffith JL. Building resilience and mobilizing hope in brief
psychotherapy. In Pi EH, Hoon TC, & Hermans MHM (Eds), Mental
Health and Illness Worldwide: Education about Mental Health and
Illness. New York: Springer, 2018
 Practice an Empirically-Validated
Resilience Factor
—Social Support
?Who knows what you are going through •
?Who do you turn to on your worst days •
Who is in your family? When do you see •
?them
?Who counts on you for help or support •
 Practice an Empirically-Validated
Resilience Factor
—Altruism
Look for a volunteer role he could )1(
take in which he would be helping someone
;else, perhaps by cooking
Arrange for a pet or a garden that he )2(
.could provide care for
 Strengthen Emotion Regulation

Emotion regulation is
the ability to soften strong emotions
.without reacting to them
Strengthening emotion regulation
.strengthens morale
 Strengthen Emotion Regulation

When you feel upset or stressed, how do •

you best calm yourself or restore a sense
?of peace
?What best gives you a sense of joy •
In whose presence do you most feel a •
?sense of comfort
?What is your favorite activity or hobby •
 Mobilizing Hope by
Strengthening Emotion Regulation

Ms. Awad, 35 year old Palestinian

woman, was diagnosed with cancer after
presenting to her physician with weight
loss. Her mother had died from cancer
.when Ms. Awad was a teenager
 Mobilizing Hope by
Strengthening Emotion Regulation

Two weeks earlier, Ms. Awad’s husband

contacted her doctor alarmed that Ms.
Awad seemed to be giving up, refusing to
take her chemotherapy and other
medications, neglecting care of self and
.the household
 Mobilizing Hope by
Strengthening Emotion Regulation
When asked what were the hardest
challenges of this illness, Ms. Awad
responded that it was the “wear and
:tear” involving
Chronic pain •
”Not knowing what will happen“ •
Fear of dying and leaving her children •
 Mobilizing Hope by
Strengthening Emotion Regulation

Doctor: ‘How have you responded to

’?these challenges
Ms. Awad: “I believe that our body
belongs to God and we must not destroy
it. But is hard not to grow weaker with
”.the stress of my illness
 Mobilizing Hope by
Strengthening Emotion Regulation

Doctor: ‘Until this illness, what was the

’?hardest challenge your life faced
Ms. Awad: “Death of my mother when I
”was 15 years old
Doctor: ‘What carried you through that?
’?What kept you from giving up
 Mobilizing Hope by
Strengthening Emotion Regulation

Ms. Awad: “At that age, I wasn’t strongly

connected to God, and I wasn’t married.
”.My sisters kept me from giving up
Her doctor asked more detailed questions
about the sisters— how often she saw
.them, how she contributed to their lives
 Mobilizing Hope by
Strengthening Emotion Regulation
Recognizing her reliance on relationships,
the GP asked: ‘Who else knows what you
’?are going through
Ms. Awad: “My husband and my friend,
”.Maryam. And also my oldest daughter
The doctor began organizing a plan to
involve sisters, husband, friend, and
.daughter more intensely in her care
 Mobilizing Hope by
Strengthening Emotion Regulation
Doctor: ‘Has there been a mentor who has
’?helped guide your life
Ms. Awad: My prophet Mohammad. His
mother died early, his lovely son died early, a lot
of people caused harm to him, but he didn’t
give up. He told us in Hadith

When Allah loves people, he will test them and‘

’.see if they are patient or not
 Mobilizing Hope by
Strengthening Emotion Regulation
Doctor: ‘Is there more from the Holy
’?Qur’an and Hadith that apply to your life
,Ms. Awad: “Yes
Allah is more kind to his slave than the‘
’.mother to her child
Allah loves me and wants to test me . . . .
Allah is kind with my children and has a
”.plan for me and them
 Mobilizing Hope by
Strengthening Emotion Regulation
The doctor suggested she keep repeating to
.herself the verses from the Hadith and Qur’an
:Ms. Awad added
All is good for the believer by patience or‘
’.gratitude
meaning that and,
Allah asks us not to kill ourselves by suicide or,
”.in my case, by stopping treatment
 Mobilizing Hope by
Strengthening Emotion Regulation

Doctor: ‘Although you are not yet well

enough to continue as a school teacher,
you can teach Islam to your family and
friends. You should spend every possible
minute with your son, daughters, and
’.husband
 Mobilizing Hope by
Strengthening Emotion Regulation
The doctor later reported that Ms. Awad
re-started chemotherapy and had begun
adhering to treatment. She planned
monthly visits with Ms. Awad to help
keep her morale strong. When her course
of chemotherapy ended, Ms. Awad told
her, “What doesn’t kill me makes me
”.stronger