2014-09-17 12:17:28
By Emma Young
Can you learn to be mentally tougher? Emma Young investigates the science of
mindfulness and other techniques promising to foster resilience in the face of
extreme stress.
It was one of those perfect days. I think that s what everyone remembers. And
now whenever the day s too perfect and the sky s too blue, I think: what might
happen?
Tuesday, 11 September 2001. Lisa Siegman was in her first year as principal of
Public School 3 (PS 3) in downtown Manhattan. Up on the fourth floor, the
fifth-graders classroom looked directly towards the World Trade Center. They
had a perfect view of the towers, Lisa says. The kids saw people jumping.
People were running into the halls of the school, just doubled over.
PS 3 was far enough away to escape evacuation. But children from two other
schools, PS 150 and PS 89, which were closer to the devastation, were sent
there for safety. By the afternoon, the school had been identified as a
potential site for a temporary mortuary. Refrigerated trucks were lining up
outside, along Hudson Street.
Children all across the city were affected. By the end of that day the
September 11th Fund had been established by two major local charities.
Donations poured in. Money first went on immediate aid hot meals for rescue
workers, emergency cheques for victims and their families and then funds were
made available for programmes to help New Yorkers to recover. The damage wasn t
only physical, but psychological. Counsellors set up services in local
churches, and psychiatrists came from around the country to offer their
expertise and their insights. Thoughts turned to the city s children how
would they deal with the stress and trauma?
Into the debate stepped Linda Lantieri. A former school principal in East
Harlem and administrator with the city s Department of Education, she had
helped to develop social and emotional learning programmes for US schools, and
was head of the National Center for Resolving Conflict Creatively, an
organisation she d co-founded to tackle school violence. Helping kids handle
trauma and manage their emotions was Lantieri s forte. She approached the Fund
with her own take on resolving the problem: enhancing resilience a person s
ability to get through difficult circumstances without lasting psychological
damage.
Since then similar programmes to encourage resilience have been introduced in
schools all over the world, both to help children recover from trauma, but also
cope better with their day-to-day stresses. Many use techniques such as
mindfulness , which some claim can foster a stronger state of mind. Meanwhile,
researchers have been studying adults who have thrived under severe stress to
try and identify what it takes to be truly resilient. Can you really teach
people to be mentally tougher?
(Justin Sullivan/Getty Images)
After 9/11, many were indirectly affected by the trauma of the day,
particularly children (Justin Sullivan/Getty Images)
For scientists the concept of psychological resilience began in the 1970s with
studies of children who did fine or even well in life despite significant
early adversity, such as poverty or family violence. For a long time a person s
level of resilience was thought to be inherited or acquired in early life. This
idea was supported by the often-replicated statistics on what happens after a
trauma: while most people bounce back to normal relatively quickly, and some
even report feeling psychologically stronger afterwards than they did before,
about 8% develop post-traumatic stress disorder, according to US figures.
Dennis Charney at the Icahn School of Medicine at Mount Sinai, New York City
and Steven Southwick at the Yale School of Medicine have avidly studied people
to find out why some are more resilient than others.
Extreme stress
People whose bodies respond rapidly to a threat with a surge of the stress
hormones adrenaline, noradrenaline and cortisol but who then recover quickly
seem to cope better with stressful situations and jobs, such as working in the
military.
More resilient people also seem to be better at using the hormone dopamine
which has a role in the brain s reward system to help keep them positive
during stress. Charney s team, along with colleagues from the National
Institutes of Health, studied a group of US Special Forces soldiers. They found
that the amount of activity in the reward systems of the soldiers brains
remained high when they lost money in an experimental game, unlike in the
brains of regular civilian volunteers. This suggests the system in resilient
people s brains may be less affected by stress or adversity. Each of the
soldiers brains also featured a healthily large hippocampus (which as well as
enabling the formation of new memories also helps regulate the release of the
fight-or-flight hormone adrenalin) and a strongly active prefrontal cortex, the
brain region dubbed the seat of rational thinking . This in turn helps inhibit
the amygdala, the part of the brain that processes negative emotions such as
fear and anger, allowing the prefrontal cortex to come up with a sensible plan
to cope with a threat.
(Getty Images)
(Getty Images)
Charney and Southwick have also investigated the psychological attitudes and
mental strategies linked to resilience. Their interviewees include former US
prisoners of war in Vietnam, victims of sexual abuse in Washington DC,
survivors of an earthquake in Pakistan, and later people who were hit hard by 9
/11. We started out with a blank slate, Charney says. To the people who
recovered well, they asked: Tell us how you made it? What were the factors?
Through their research, Charney and Southwick have identified 10 psychological
and social factors that they think make for stronger resilience, either alone
or ideally in combination:
- facing fear
- having a moral compass
- drawing on faith
- using social support
- having good role models
- being physically fit
- making sure your brain is challenged
- having cognitive and emotional flexibility
- having meaning, purpose and growth in life
- realistic optimism.
Charney and Southwick are convinced that it is possible to develop these 10
factors, and that this can lead to a positive change for generally healthy
people in their ability to cope not just with a major trauma, but also with the
day-to-day stresses of life. One technique, in particular, might help people
with this development. Until recently this technique was relatively obscure.
Now it s everywhere: mindfulness.
(Getty Images)
(Getty Images)
Mindfulness has its origins in the Zen Buddhist tradition, but its central
ideas involving attention and awareness are secular. A modern explanation
is that it means paying attention, on purpose, in the present moment and
non-judgementally, to the unfolding of experience, moment to moment.
Mindful practice
Lantieri believes that mindfulness and other fundamental stress-reducing
strategies are vital foundations for the kinds of changes Charney talks about.
Many of the factors he mentions are internal strengths that can be cultivated
through mindfulness such as cognitive and emotional flexibility or facing
fear. We can t just tell people that it s better to face their fear without
helping them figure out how, she says.
In September 2001, as New Yorkers began to clear away the physical debris of
the terrorist attacks, Lantieri developed her Inner Resilience Programme for
teachers. Working with them, she developed a suite of tools to promote
mindfulness in the classroom, to help children cope not only with serious
traumas, like the terrorist attacks, but also with more everyday stressors,
from exams to poverty to conflict in the home. The tools include deep breathing
exercises designed to improve conscious awareness of the body and how to calm
it down, in part to tackle stress and anxiety, and in theory to boost long-term
psychological resilience.
Lantieri s is one of the longest-running resilience-building programmes for
schools, but it isn t the only one out there. The concept of resilience both
in schools and beyond the classroom is a hot one. In February 2014 a UK
cross-party government group produced a report calling for schools to promote
character and resilience . May 2014 saw the launch of an all-party group to
explore the potential for mindfulness in education, as well as in health and
criminal justice.
(Joe Raedle/Getty Images)
Children sing at St John Baptist Church in New York, in honour of the victims
of 9/11 (Joe Raedle/Getty Images)
Mark Williams, director of the Oxford Mindfulness Centre at the University of
Oxford, is the joint-developer of a technique for treating depression called
mindfulness-based cognitive therapy. It involves encouraging patients to be
aware of their thoughts and to accept them, without judgement. Research shows
that it may be as effective as drugs at cutting the chances of a person who s
experienced one episode of major depression from suffering another.
Meanwhile, in 2010 a pair of former teachers in the UK got together to develop
the Mindfulness in Schools Project. They developed a nine-lesson curriculum to
teach kids mindful meditations, such as body scanning , to encourage them to
keep their attention focused in the present, and to help them deal with stress.
And Martin Seligman (sometimes dubbed the father of positive psychology ) and
a team at the University of Pennsylvania have developed the Penn Resiliency
Program for late elementary and middle school students. Here the focus is on
the content of thoughts. Over 12 sessions lasting 90 minutes, students are
taught to detect inaccurate thoughts, evaluate the accuracy of them and
challenge negative beliefs by considering alternative explanations (that
popular girl just ignored me in the corridor because she didn t see me, not
because she hates my guts). Students are also taught techniques for
assertiveness, negotiation, decision-making and problem solving, as well as
relaxation.
On what evidence?
But do these programmes work? The effects of Mindfulness in Schools curriculum
rolled out in six participating schools have been scrutinised in a pilot
study conducted by Willem Kuyken at the University of Exeter along with other
researchers who have worked with Williams. The results, published in the
British Journal of Psychiatry in 2013, found that the curriculum had promising
but small effects on stress levels and wellbeing. The researchers would
like to investigate this further in a large-scale randomised controlled trial
of the curriculum in British secondary schools.
The Penn Resiliency Program has been evaluated in the US and the UK, and again
the effects are small, although statistically significant. There was a small
average impact on pupils depression scores, school attendance and English and
maths grades , according to the UK report, but this only lasted until the
one-year follow-up study. By the two-year follow-up its impact had vanished.
(Thinkstock)
(Thinkstock)
This doesn t mean the programmes aren t useful, says Kuyken. Studies that
involve giving an intervention to everybody, whether or not they have a
problem, generally only get small overall results. What these interventions
have the potential to do is move the bell curve that is, to help those most
at risk of depression at one end of the curve, but also those who are
flourishing and those in the middle who represent most people, he says.
Still, there s no silver bullet when it comes to resiliency in kids, says Ron
Palomares, a school psychologist at Texas Woman s University. Between 2000 and
2013 he worked on the American Psychological Association s Road to Resilience
campaign, which it set up after 9/11 to provide public information on how to
become more resilient. For adolescents with depressive symptoms, perhaps the
Penn Resiliency Program approach may work best, he says. The mindfulness
programmes being developed in schools in the US and the UK are focused more on
emotional regulation, which some kids may need help with but others won t.
The multifaceted approach of the Lantieri s Inner Resilience Programme (IRP),
meanwhile, may be best for a group, like an entire school, because it s more
likely to cover the various needs of most of the pupils. Yet, compared to the
formal programmes, Lantieri s IRP is more of a bag of tricks or a bag of
practical strategies as she describes it. She says she wants to give adults
and kids options, as many as possible, to help children cope with whatever life
throws at them. As much as we like to think we can protect our children from
what may come their way, we live in a very complex and uncertain world, she
says. We have to give them all the skills of inner resilience, so they re
ready for just everyday life.
(Getty Images)
(Getty Images)
The IRP has been adopted by schools in Ohio and Vermont as well as Manhattan,
and a pilot project has been launched in Madrid, Spain. Lantieri estimates that
more than 6,000 teachers and 40,000 students have been exposed to it. There
have been various evaluations, but Lantieri is not aware of any formal
assessment. Given the pick-and-mix adoption of the programme some using IRP
strategies often and others not at all formal evaluation would be tricky in
any case. It is very organic, Lantieri says. It has to be, because every
school is such a mix of people and attitudes and experiences. You can t make
everybody do the same.
Principal Eileen Reiter of New York City s PS 112 has been teaching for 50
years. Interventions have come and gone, but for her the IRP s focus on
teachers as well as children sets it apart. She shares Lantieri s view that if
teachers are calm and nurtured, they ll be in a better place to help their
children. It s about taking care of the teachers so they can take care of the
kids, she says. And these particular children need all the help they can get.
We have a lot of kids being raised by grandparents, or in foster care, says
Reiter. Some live in shelters, some have one parent, or both, in prison. Many
of the kids also have special educational needs.
When the Twin Towers came down, Reiter had just recently become principal.
Everybody [had] felt safe before that, she says. It was an eye-opener for
everybody. That was when we really had to think more deeply about how we
support kids who are living in a lot of stress, just in general.