Resilience is a word that comes up in challenging times, and for many, the COVID-19 pandemic was profoundly difficult. Living with the constant threat of the virus—and having to wear masks and social distance to prevent it—has had an enormous impact on everyone’s mental health. Reports of anxiety and depression have skyrocketed over the past two years. And yet, according to mental health experts, most individuals have shown signs of resilience.
But what, exactly, is it?
Resilience is the process of adapting well in the face of tragedy, trauma, threats, or significant sources of stress. The good news, says Jacob Tebes, PhD, a psychologist at Yale School of Medicine, is that there are many ways to promote it.
“It’s important to know that resilience not something that is ‘inside’ a person, but rather a process influenced as much or more by factors ‘outside’ the person that can lead to better health,” says Tebes. “Everyone shows some evidence of resilience at least in a few domains, and they can employ strategies that lead to it.”
For the last two years, Tebes and more than a dozen of his Yale colleagues supported health care workers and other members of the Yale community who were navigating the emotional fallout from the pandemic. As many as 4,000 health care workers, staff, faculty, students, and their families from Connecticut, Rhode Island, and New York attended over 150 Stress and Resilience Town Halls.
These gatherings were designed to be a virtual and interactive space where people could feel comfortable supporting one another by sharing their stressors and resilience strategies. Psychologists and psychiatrists facilitating the town halls could then reinforce evidence-based strategies that were shared.
Tebes and his colleagues identified eight resilience strategies used by town hall participants that helped them significantly during a difficult time. Tebes says they align with research on resilience, which means they can work for others during the pandemic or in coping with other life stressors.
1. Practice acceptance
The most common strategy was to practice acceptance. This could mean adopting a strategy that involved taking things one day at a time, being patient, and focusing on what was possible in the moment. “For example, some people might say, ‘This event is horrible, and there is nothing I can do,’” says Ke Xu, MD, a Yale psychiatrist who led some of the town halls. “But other people view the same event differently, saying, ‘This is out of my control, but I can focus on what I can do.’”
Practicing acceptance can take work, admits Tebes. “For example, many people found themselves routinely irritated by small things their partner or child might do—and maybe they also were feeling stress at not handling every interaction as well as they could have,” he says. To accept that everyone is human, including yourself, and that others aren’t always going to be perfect was critical, especially when the whole family was at home in close quarters, he explains.
For those who lived alone, this meant accepting solitude, he adds. “Some people were able to say, ‘Through this, I've learned to spend more time with myself and to appreciate the things that I didn't before.’”
It is important to acknowledge the stress a situation is causing before a person can truly accept it, explains Dr. Xu. Acceptance is a process. Some participants came to acceptance only after talking about it openly in the town hall, without fear of judgment, she adds. After that, they found it easier to differentiate between what they could control and what they could not.
2. Use positive reappraisal
Positive reappraisal is reframing a negative event in a more positive way. “That was a common thing we heard from many people,” Tebes says. “An example: shifting from thinking about what the pandemic prevented you from doing—going to concerts or visiting friends—to focusing on what it meant you could do: read or cook more, or maybe use Zoom to reconnect with friends who live far away.”
Gratitude is an important aspect of positive reappraisal—and it can take practice, Tebes says. In one town hall, a participant said they set aside a few minutes each night to list five things they were grateful for. But for others, finding gratitude was difficult. “One participant said it was difficult to come up with even one thing. But a month later, that person went to a different town hall and said, ’I've been practicing gratitude, and I feel so much better about things,’" Tebes said.
3. Build social connections
Isolation was a topic in most town hall conversations, and it manifested differently in people. “Some were really traumatized by the pandemic and didn’t want to do anything at first. But later they found ways to reach out to people,” Dr. Xu says. “Others were very positive in the beginning, but later they felt fatigued and found things very difficult, which led to depression.”
Some people were also more comfortable reaching out than others, Dr. Xu adds. She started a Zoom-based weekly town hall for people with connections to China, conducted in Chinese, and drew participants from around the U.S. and also from Europe. “In China, we are a very connected culture, so we have the idea that we’re not alone,” she says.
Chinese students who attended arranged groups online to watch movies together, dance together to YouTube videos, or cook a meal at the same time. Some students took pictures of each meal they cooked and sent the pictures to their parents in China, so their parents would not worry about them as much. “They stretched outside themselves, and it helped them to cope,” she says.
Other people who weren’t used to reaching out made a list of people they could call, says Tebes. “They would connect with an old friend or would put energy into having a more intimate conversation with friends they were in contact with. And that changed their perception over time. Some said they felt they could now connect with anybody at any time, no matter what happens.”
4. Practice self-care
Self-care means different things to different people. Many who had a routine, such as going to the gym or playing a weekly basketball game, established new plans for exercising or otherwise taking care of themselves during the pandemic. For instance, they might have spent time outdoors, taken long walks, started hiking, and/or focused on better sleep.
Prayer, faith, meditation, mindfulness, and religion also came up in conversations, and some people who hadn’t devoted time to religion before tried attending Zoom services. “In a time of uncertainty, people look for purpose and meaning, and they try to make sense of things,” says Yale psychologist Michelle Silva, PsyD, who led some of the town halls.
Silva, who worked with parents and families, found that for mothers, just carving time out for themselves wasn’t enough. “If being a parent is your valued role, then doing something relaxing, like taking a bath, may not always match up with personal expectations,” Silva says. “Instead, maybe spending time with your child, whether it’s five minutes reading to them or playing a game, may feel more fulfilling and contribute to your overall wellness.”
5. Engage in valued activities
Many people reported that seeking out new experiences was helpful. Some joined online book clubs and singing groups. They baked, cooked, and did volunteer work. They also spent time on “activities that bring uplifting feelings,” like spending time in nature. “My daughter learned how to ski during the pandemic, and then I did, too, because I wanted to ski with her,” says Dr. Xu. “I was so scared at my age because I had never skied before. But it impacted me in such a good way. You’re in the woods and under the sun—you feel the pandemic is far away from you, and that was freeing mentally.”
6. Make adjustments at work
Managers have had to adjust things constantly, says Tebes. For instance, they had to be flexible with disruptions, such as school closings, that forced parents to take days off with little notice. Some managers whose staff shifted to working remotely had regular check-ins to take everyone’s “emotional temperature,” he says. Others who worked remotely made efforts to stay in touch with each other through Zoom meetings or created a “buddy system” in which they checked in regularly with a colleague.
There was also reflection about the importance of “meaningful work,” leading some people to change their jobs or careers, which Dr. Xu thought was a healthy step. “Some people are changing the trajectory of their lives,” she says. “They are not staying in jobs that make them unhappy. Some retired earlier than they had planned. The pandemic has changed the way we think about our lives.”
7. Make family/parenting adjustments at home
Families talked about the stress of juggling the care of children (or an elderly loved one) with their jobs, feeling ineffective both at home and at work, and frustrated about the constant changes to their routines. Some tried trading off homeschooling responsibilities among family members, and others planned breaks from work to have meals with their children.
Even with these strategies, stress in families was compounded by general feelings of grief that people felt to varying degrees—depending on their experience—which could be difficult to communicate with words, especially for children, Silva says. Children missed their school friends, and teenagers mourned missed proms and graduations, she says. “It was important to provide space to name these losses and honor them, versus following the urgency to just say, ‘We're just going to adapt, get through it, and move forward,’” she says.
Silva says many parents had questions about whether or not certain behaviors were worrisome. “It was hard for parents to know when it was normal for their teenager to go into their room because, for example, they wanted their own space, and when it became an issue of concern,” she says.
One solution was to keep talking to children and teenagers about how everyone was feeling—and to listen to their responses, Silva says. “We spoke a lot about what the particular stressors were and, at the same time, used them as opportunities to open conversations with kids by asking, ‘What do you miss the most? What will you do differently when you go back?’”
For children who were isolated, parents could talk about what activities their kids could re-introduce that would be considered socially safe, Silva says.
8. Limit news/media consumption
Feeling overwhelmed by the news was a common complaint. “All news is breaking news, and I feel scared after I watch it,” said one town hall participant. A health care worker expressed concern about the circulation of false information after a patient announced that “COVID was just a hoax.” Others worried that pandemic safety measures were being politicized.
Some participants reduced their news consumption, particularly before bed. Some put their cellphones out of reach, and others watched sports highlights or listened to music instead. “I didn’t handle the news well,” says Dr. Xu. “I quit my Facebook and Twitter accounts early in the pandemic. Instead, I watched movies, maybe a light TV show, and got my news from TV and the newspapers. Sometimes, if I saw something from the news that I wanted to know more about, I would forward it to my husband and say, ‘You read it and let me know.’”
How to tell if you might benefit from professional help
None of this is to say the pandemic has been easy on anyone. “Many of the feelings that were coming up—the experiences and fears—were shared by everybody,” says Silva. “Much of what we spoke about was that sense of not having emotional and psychological safety—and how much we all need that.”
Shortly after the start of the pandemic, a joint Yale School of Medicine/Yale New Haven Health task force was formed. It created a range of approaches, including the Stress and Resilience Town Halls, to support health care workers and others in the Yale community. A website, Yale Care for the Caregivers, was also developed; it included resources and supports to promote resilience.
The website also hosted an anonymous stress self-assessment survey that allowed individuals to track their own stress over time. Survey results showed that 69% of respondents reported feeling tired, exhausted, or fatigued; 57% said they felt anxious, tense, nervous, irritable, frustrated, emotional, or had sleep difficulties. Many also reported having a general sense of guilt for no apparent reason and feelings of uncertainty about the future.
Some individuals took advantage of professional help, Tebes says. “That's because they were recognizing that they weren't at their best,” he says, and getting treatment became important, even critical in some cases.
But he also thinks many people struggling right now might benefit from developing one or more resilience practices like those described in the town halls. “Establishing tools people can use every day to help boost their mental health has a profoundly positive effect,” he says. “And these strategies are available. You can do them whenever you need them.”