Phoenix Rising: A Resilience-Oriented Approach to Care for the Behavioral Medicine Practitioner

Terence Matthew Penn, MA^✉; Student SIG

Humans are an incredibly resilient and adaptive species. Like a phoenix rising from the ashes, we have survived – and thrived – under countless crises including war, famine, plague, and natural disaster. Thus, it is reasonable to assume that everyone has the capacity to remain resilient in the face of adversity. It is my belief that recognizing and trusting the human potential of resilience is the foundation to ensuring a successful therapeutic intervention.

As captured by the Merriam-Webster Dictionary, resilience refers to the “ability to recover from or adjust easily to misfortune or change.” Resilience captures both the necessity to accept the negatives in life and the acknowledgement that we have or can develop the skills necessary to manage life’s difficulties. For the client to reach this actualization, it is imperative for the therapist to provide a safe, encouraging environment. Client rapport is earned by the therapist demonstrating empathic understanding, unconditional positive regard, and tactfully honest communication. This enables clients to appropriately process thoughts and emotions relating to the presenting complaint, under the guidance of the therapist.

Therapy is a process of change; therefore, the focus must pivot from guided reflection to concrete action on the part of the client. Utilizing elements of Motivational Interviewing, this transition can be achieved by helping the client identify discrepancies between their current behavior and personal values and by portraying the client as a capable agent of change who bears the responsibility for resolving the presenting complaint.

From a cognitive behavioral framework, I guide the client to examine the bidirectional relationships between their thoughts, emotions, and behaviors. As a case example, an individual with chronic pain experiences a maladaptive automatic thought in reaction to a pain flare (e.g., “This pain will never end”), leading to panic and subsequent abnormal, shallow breathing. To break this cycle, one approach may consist of replacing the automatic thought with an adaptive one (e.g., “This flare is temporary”).

Emotion follows action: psychologist William James was one of the first to propose this theory, now supported by numerous studies. In my clinical experience, initially targeting behavioral changes before maladaptive thoughts has the advantage of building client self-efficacy due to how quickly behavior can influence emotion. In the case of the above example, I may start by providing psychoeducation about the influence of breathing on the central nervous system and emotion, then proceed to invite the client to participate in my demonstration of diaphragmatic breathing and/or coherent breathing.

In conjunction, I apply a strengths-based approach to further build client resilience. Particularly, I guide clients to identify personal strengths and values that can be generalized into strategies and applied to the presenting complaint. In other words, I help individuals recognize they already have tools within themselves to overcome challenges.

Ultimately, the client’s persistence and genuine attempts to change are the most important aspects to reinforce, especially when the individual perceives failing to achieve a desired outcome. Each subsequent attempt to change becomes easier over time, regardless of the result: resilience is the culmination of this process.

Growing evidence suggest that resilience-oriented interventions, particularly those based on a combination of cognitive behavioral and mindfulness strategies, result in improved psychological and physical health.¹ While the majority of such studies examine traditional face-to-face formats, emerging research is now exploring resiliency training delivered via digital health platforms. As it relates to behavioral medicine, resilience-oriented therapy may particularly benefit individuals at risk for exposure to trauma or distress in medical settings, including health care professionals and patients with acute and chronic illness.

 

References

1. Joyce, S., Shand, F., Tighe, J., Laurent, S. J., Bryant, R. A., & Harvey, S. B. (2018). Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ open, 8(6).