Can Tragedy Teach Resilience, and Can It Last?
On the morning of Dec. 14, 2012, Michele Gay decided not to put her daughter Josephine on the school bus. The first-grader was recovering from a concussion, and Michele thought a little more rest at home might be good for her. But Joey, as she was affectionately called, really wanted to go to school that day. So Gay relented and drove her in a little late.
The mother of three dropped her youngest daughter off at Sandy Hook Elementary School just minutes before a gunman burst in. His massacre left 20 first-graders and six adults dead.
For hours, Michele Gay waited with about 25 other families in the banquet room of the local firehouse for their children to appear. Since Joey had autism, was non-verbal and had an aide with her at all times, Gay believed her youngest had likely been taken to another location and would be found soon.
Instead, she felt blindsided when police finally told her Joey was dead.
“When they told us all at once, it was a disaster. At that point there was no hearing any more information. It was obviously too much for any of us to handle,” Gay recalls.
Gay and her husband went to their car, distraught, and prayed. Then they drove home, without their little girl who loved the color purple, “Fancy Nancy” books and watching football with her family. Joey had turned 7 just 3 days earlier and the whole family had been excited for her birthday party scheduled for the next day. The purple cupcakes already sat in their refrigerator.
While much of that day is a blur, Gay says after hours of trying to hold it together for her family, she had a moment of clarity while sitting in her car in the school parking lot before heading home.
“I remember having the realization that I would fall apart soon,” Gay says. But she also vividly recalls vowing to herself that one day when she picked herself up again, she would use the pain she was feeling to help others.
“I remember making this choice almost like a promise to myself and my daughter,” she says.
Six months later her family teamed up with another Sandy Hook family to form Safe and Sound Schools. The nonprofit serves as a national network of school tragedy survivors and experts on all aspects of school safety, including mental health, physical safety, culture, and climate.
“Safe and Sound is part of our healing and resilience journey. It is about looking at the shattered remains in front of you and trying to find a way to re-assemble them into something useable for yourself and others,” Gay explains. “Resilience for us has meant taking control of these really difficult circumstances by choosing to help others.”
The Rise of Resilience Research
The idea that you have the power to build your resilience is fairly new, but it’s being widely studied and embraced for its benefits to health and overall well-being.
“Originally we thought people were born with characteristics of resilience or a more positive outlook. But now we understand those are things you can definitely learn to do,” says Anita Thomas, PhD, dean of the College of Applied Behavioral Sciences at the University of Indianapolis.
Resilience is the ability to bounce back from adversity and deal with life’s downturns and challenges -- even when those events are so catastrophic, surprising, overwhelming, or devastating that they seem impossible to recover from.
It isn’t the absence of stress or suffering, but how you adapt and deal with it.
“Resilience is not a trait. It’s not like brown eyes that you have or don’t. It truly is a mental muscle that can be learned and practiced and incorporated into everyday life,” says Joanne Pedro-Carroll, PhD, a clinical psychologist in Rochester, NY, who’s written several articles on resilience and a book that talks about it.
Depression: What Is It?
It's natural to feel down sometimes, but if that low mood lingers day after day, it could signal depression. Major depression is an episode of sadness or apathy along with other symptoms that lasts at least two consecutive weeks and is severe enough to interrupt daily activities. Depression is not a sign of weakness or a negative personality. It is a major public health problem and a treatable medical condition.
Depression Symptoms: Emotional
The primary symptoms of depression are a sad mood and/or loss of interest in life. Activities that were once pleasurable lose their appeal. Patients may also be haunted by a sense of guilt or worthlessness, lack of hope, and recurring thoughts of death or suicide.
Depression Symptoms: Physical
Depression is sometimes linked to physical symptoms. These include:
Fatigue and decreased energy
Insomnia, especially early-morning waking
Excessive sleep
Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
Depression can make other health problems feel worse, particularly chronic pain. Key brain chemicals influence both mood and pain. Treating depression has been shown to improve co-existing illnesses.
Depression Symptom: Appetite
Changes in appetite or weight are another hallmark of depression. Some patients develop increased appetite, while others lose their appetite altogether. Depressed people may experience serious weight loss or weight gain.
Impact on Daily Life
Without treatment, the physical and emotional turmoil brought on by depression can derail careers, hobbies, and relationships. People with depression often find it difficult to concentrate and make decisions. They turn away from previously enjoyable activities, including sex. In severe cases, depression can become life-threatening.
Suicide Warning Signs
People who are depressed are more likely to attempt suicide. Warning signs include talking about death or suicide, threatening to hurt people, or engaging in aggressive or risky behavior. Anyone who appears suicidal should be taken very seriously. Do not hesitate to call one of the suicide hotlines: 800-SUICIDE (800-784-2433) and 800-273-TALK (800-273-8255). If you have a plan to commit suicide, go to the emergency room for immediate treatment.
Depression: Who's at Risk?
Anyone can become depressed, but many experts believe genetics play a role. Having a parent or sibling with depression increases your risk of developing the disorder. Women are twice as likely as men to become depressed.
Causes of Depression
Doctors aren't sure what causes depression, but a prominent theory is altered brain structure and chemical function. Brain circuits that regulate mood may work less efficiently during depression. Drugs that treat depression are believed to improve communication between nerve cells, making them run more normally. Experts also think that while stress -- such as losing a loved one -- can trigger depression, one must first be biologically prone to develop the disorder. Other triggers could include certain medications, alcohol or substance abuse, hormonal changes, or even the season.
Seasonal Depression
If your mood matches the season -- sunny in the summer, gloomy in the winter -- you may have a form of depression called seasonal affective disorder (SAD). The onset of SAD usually occurs in the late fall and early winter, as the daylight hours grow shorter. Experts say SAD affects from 3% to 20% of all people, depending upon where they live.
Postpartum Depression
The "baby blues" strikes as many as three out of four new mothers. But nearly 12% develop a more intense dark mood that lingers even as their baby thrives. This is known as postpartum depression, and the symptoms are the same as those of major depression. An important difference is that the baby's well-being is also at stake. A depressed mother may have trouble enjoying and bonding with their infant.
Depression in Children
In the United States, depression affects 2% of grade school kids and about one in 10 teenagers. It interferes with the ability to play, make friends, and complete schoolwork. Symptoms are similar to depression in adults, but some children may appear angry or engage in risky behavior, called "acting out." Depression can be difficult to diagnose in children.
Diagnosing Depression
As of yet, there is no lab test for depression. To make an accurate diagnosis, doctors rely on a patient's description of the symptoms. You'll be asked about your medical history and medication use since these may contribute to symptoms of depression. Discussing moods, behaviors, and daily activities can help reveal the severity and type of depression. This is a critical step in determining the most effective treatment.
Talk Therapy for Depression
Studies suggest different types of talk therapy can fight mild to moderate depression. Cognitive behavioral therapy aims to change thoughts and behaviors that contribute to depression. Interpersonal therapy identifies how your relationships impact your mood. Psychodynamic psychotherapy helps people understand how their behavior and mood are affected by unresolved issues and unconscious feelings. Some patients find a few months of therapy are all they need, while others continue long term.
Medications for Depression
Antidepressants affect the levels of brain chemicals, such as serotonin and norepinephrine. There are many options. Give antidepressants a few weeks of use to take effect. Good follow-up with your doctor is important to evaluate their effectiveness and make dosage adjustments. If the first medication tried doesn't help, there's a good chance another will. The combination of talk therapy and medication appears particularly effective.
Exercise for Depression
Research suggests exercise is a potent weapon against mild to moderate depression. Physical activity releases endorphins that can help boost mood. Regular exercise is also linked to higher self-esteem, better sleep, less stress, and more energy. Any type of moderate activity, from swimming to housework, can help. Choose something you enjoy and aim for 20 to 30 minutes four or five times a week.
Light Therapy (Phototherapy)
Light therapy has shown promise as an effective treatment not only for SAD but for some other types of depression as well. It involves sitting in front of a specially designed light box that provides either a bright or dim light for a prescribed amount of time each day. Light therapy may be used in conjunction with other treatments. Talk to your doctor about getting a light box and the recommended length of time for its use.
St. John's Wort for Depression
St. John's wort is an herbal supplement that has been the subject of extensive debate. There is some evidence that it can fight mild depression, but two large studies have shown it is ineffective against moderately severe major depression. St. John's wort can interact with other medications you may be taking for medical conditions or birth control. Talk to your doctor before taking this or any other supplement.
Pets for Depression
A playful puppy or wise-mouthed parrot is no substitute for medication or talk therapy. But researchers say pets can ease the symptoms of mild to moderate depression in many people. Pets provide unconditional love, relieve loneliness, and give patients a sense of purpose. Studies have found pet owners have less trouble sleeping and better overall health.
The Role of Social Support
Because loneliness goes hand-in-hand with depression, developing a social support network can be an important part of treatment. This may include joining a support group, finding an online support community, or making a genuine effort to see friends and family more often. Even joining a book club or taking classes at your gym can help you connect with people on a regular basis.
Vagus Nerve Stimulation (VNS)
Vagus nerve stimulation (VNS) may help patients with treatment-resistant depression that does not improve with medication. VNS is like a pacemaker for the brain. The surgically implanted device sends electrical pulses to the brain through the vagus nerve in the neck. These pulses are believed to ease depression by affecting mood areas of the brain.
Electroconvulsive Therapy (ECT)
Another option for patients with treatment-resistant or severe melancholic depression is electroconvulsive therapy (ECT). This treatment uses electric charges to create a controlled seizure. Patients are not conscious for the procedure. ECT helps 80% to 90% of patients who receive it, giving new hope to those who don't improve with medication.
Transcranial Magnetic Stimulation
A newer option for people with stubborn depression is repetitive transcranial magnetic stimulation (rTMS). This treatment aims electromagnetic pulses at the skull. It stimulates a tiny electrical current in a part of the brain linked to depression. rTMS does not cause a seizure and appears to have few side effects. But doctors are still fine-tuning this treatment.
Good Outlook
In the midst of major depression, you may feel hopeless and helpless. But the fact is, this condition is highly treatable. More than 80% of people get better with medication, talk therapy, or a combination of the two. Even when these therapies fail to help, there are cutting-edge treatments that pick up the slack.
A growing body of research now looks at resilience as a way to retrain your brain to help you handle everything from major crises to daily life stress. Studies show it has benefited health, well-being, and stress management for cancer survivors, medical providers, college students, immigrants, office workers, and others.
“Resilience is the core strength you use to lift the cognitive and emotional load of life. If you are carrying an excessive load, you can either decrease the load or increase your capacity to lift the load,” says Amit Sood, MD, a professor of medicine at the Mayo Clinic in Rochester, MN, and author of The Mayo Clinic Handbook for Happiness. “Decreasing the load isn’t easy or always possible, but the second option -- increasing your resilience -- is.”
Sood and his team have done more than 20 clinical trials on resilience and report that while about 50% is genetic, the other half is acquired, to a great extent, through your choices. “The cutting-edge discovery is that resilience can be moved,” Sood says. “By training, we can enhance people’s resilience. That to me is where there is the greatest impact and interest of hospitals and doctors and patients.”
He says several studies have shown that working to boost a person’s resilience makes a measurable difference in their stress, anxiety, emotional health, mindful attention, and overall quality of life.
“Even a small improvement in resilience is associated with much larger improvement in stress measures,” Sood explains. “You can improve your resilience by 10 or 20%, and for each unit of improvement, you decrease your stress by 20 to 30%. That means if your resilience goes up 10%, your stress can go down 30% or more.”
The Basics of Resilience Training
There’s no one type of resilience training. It varies greatly in terms of content and length. But in general, it involves helping people cultivate several principles in their daily life, including gratitude, self-compassion and forgiveness, as well as the ability to let go of the uncontrollable, to focus on the positive rather than the negative, and to find meaning in life. Getting there involves strategies like deep breathing, meditation, relaxation, goal-setting, and mindfulness.
“We spend a lot of our days on automatic pilot, so it’s only when we get caught with something that is unexpected or surprising or traumatic that our coping styles or lack thereof come into play,” Thomas says. “Resilience is about catching your thoughts, changing the way you think, and learning to develop an action plan to figure out the best way to move forward during stressful times.”
Margie Ruttenberg, 54, of Pittsburgh says her resilience has grown gradually since she was diagnosed with Hodgkin’s lymphoma that has come back about once a year for 9 years. Resilience hasn’t changed her diagnosis, but she says it has been an important way to help her cope. “Cancer has taught me that I am more resilient and stronger than I thought,” she says. “In the beginning, I spent some time questioning why this was happening to me. But then I realized this isn’t my fault. You can either fight your challenges or run from them, and I decided I’m going to be resilient. I’m not going to run.”
Researchers say that is a key part of resilience -- learning to take control of your thoughts by being mindful rather than letting your mind wander.
“We help people become intentional and engage their brain to make it stronger,” Sood explains. “Studies show the average person’s mind wanders 50 to 90% of the time, so we help people become aware of how, from a neuroscience perspective, they are depleting themselves when they let this happen.”
Researchers stress that resilience training should not take the place of mental health services or needed medical treatment. There are also critics who say the field needs more consistency and an agreed-upon definition of resilience. Others believe progress is hard to verify and that some studies cast doubt on just how much improvement training produces.
The Mayo Clinic has created resilience training programs online and in person that have engaged with half a million people over the last 8 years. The hospital now requires resilience training for all new doctors and nurses, and it isn’t alone in embracing the concept.
The U.S. Army teaches resilience training to soldiers, their families, and Army civilians. The concept is being taught more in the corporate world, and Ronald Breazeale, PhD, a clinical psychologist in Portland, ME, says he’s led workshops on the subject to law enforcement, federal disaster crews, university students, teachers, and others.
“It’s really a set of skills and attitudes, and like anything else, the more you practice and apply it, the better you get at it. It involves problem-solving, flexibility, finding a sense of purpose and meaning, being able to help other people, and taking good care of yourself in the process,” Breazeale says. “It can make a major difference when people take it seriously.”
How to Increase Your Resilience
Wondering if you need to increase your resilience? Sood suggests asking yourself a simple question.
“Over the last month, how stressed have I felt on a scale of 1 -- being not at all -- to 10,” he says. “If you are above a 5, you can be helped by resilience.”
Experts say you become more resilient through lifestyle changes that focus on five domains:
Physical: Eating a healthy diet can make you happier and physically healthier, and regular exercise and sleep can improve your emotions, focus, and health.
Cognitive: Enhancing your focus and improving your mindset through practices like mindfulness, meditation, and yoga
Emotional: Working to boost your ability to sustain positive emotions and recover quickly from negative ones
Spiritual: Living a life full of meaning -- volunteering or doing substantial work that helps others and gives you purpose, hope, and meaning
Social: Having good, nurturing relationships to help you better withstand life’s challenges
Thomas, who specializes in resilience in African-American young people and women, says minorities often need an extra action step in their resilience training that involves learning to deconstruct or depersonalize an experience. “There is an awareness piece around identity and thinking carefully about whether or not something is about you or the other person,” she says.
It takes time for these practices to become a habit, and experts stress it is less about trying to reach some sort of endpoint and more about creating an awareness of how you want to handle life.
“Building up resilience doesn’t mean you won’t have the stress or upset feelings,” Pedro-Carroll says. “It’s how we calm ourselves when we are really distressed and how we learn those skills to self-soothe and come through tough times with a measure of grit and gratitude.”
Resilience in Action
Ruttenberg says therapy, meditation, volunteering, a strong support system and learning as much as she can about her disease and treatment options have helped grow her resilience. She’s needed it. She’s undergone multiple rounds of chemotherapy and radiation, lost her hair three times, had a failed stem cell transplant and underwent immunotherapy. She’s now on monthly immune boosting treatment and has
I’ve learned that when I encounter a challenge, I am going to tackle it head on and just keep going because there is no alternative.
Margie Ruttenberg, 54
come to terms with the fact that for her, this will be a lifelong battle. “I can tell you that now I feel resilient and relentless,” Ruttenberg says. “I’ve learned that when I encounter a challenge, I am going to tackle it head on and just keep going because there is no alternative.”
She says her increased resilience has helped her make some difficult decisions. On the advice of her doctors, she had to put career on hold because they believe a less stressful life will lead to longer remission. She also moved from D.C. to Pittsburgh to be closer to her medical team and supportive family. “My life was about my career and so I’ve had to find a new way to believe in myself,” Ruttenberg says. “For me now, that is a big part of being strong and resilient -- making major life decisions that are important to my health.”
Honoring a Young ‘Master of Resilience’
Six years after losing her daughter, Gay says her family has slowly found their way forward. “We’ve come to understand this is a lifelong process,” she says. “People talk about recovery, and I think we often think of that as having a defined period of time. But resilience is often the recognition that there isn’t really an endpoint in terms of loss and grief and trauma.”
Even in horror’s aftermath, Gay says you learn to carry on. And in her family’s case, they do so to honor Joey and her life. “I feel like in many ways, our lives with her really strengthened our own resilience. Her life was full of challenge and adversity, yet Joey was a master of resilience. Every day, no matter how challenging it was, she got up and always had a smile on her face,” Gay says.
“We were prepared to handle this loss in ways that some other families may not have been because of what we learned from Joey. We just keep going because so did she.”