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Cultivating Deliberate Resilience During the Coronavirus Disease 2019 Pandemic

Educational Objective
To understand how to promote resilience among health care workers and organizations
1 Credit CME

Coronavirus disease 2019 (COVID-19) is affecting our health care community in unprecedented ways. As a pediatric oncologist who studies resilience in the context of illness, I started thinking about what this pandemic means for our professional resilience a few weeks ago, when the first US patient with fatal COVID-19 died in my home city of Seattle, Washington.

Promoting resilience among health care workers and organizations starts with understanding what resilience is (and what it is not). Historical psychology and social science suggested resilience was either a trait (eg, hardiness), a process (eg, adaptation), or an outcome (eg, the absence of posttraumatic stress or the presence of posttraumatic growth after a particular adversity).1 The first and last conceptualizations are questionable. The potential for resilience is not a unique trait that one has or does not have; the capacity for resilience is inherent in all people. Resilience is not a single dichotomous outcome measured at a point; we can simultaneously experience posttraumatic stress and growth, and these (and other) outcomes dynamically evolve throughout our lives. Finally, both trait and outcome conceptualizations suggest resilience is something that happens to the fortunate and something we can hope for but not necessarily achieve. This is incorrect. Resilience is neither lucky nor passive. It takes deliberate effort. Indeed, while resilience researchers have quibbled over nuanced definitions and requirements for resilience, they agree that it can be strengthened with practice.1

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Article Information

Corresponding Author: Abby R. Rosenberg, MD, MS, MA, Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, 1900 Ninth Ave, JMB 10-C, Seattle, WA 98101 (abby.rosenberg@seattlechildrens.org).

Published Online: April 14, 2020. doi:10.1001/jamapediatrics.2020.1436

Conflict of Interest Disclosures: Dr Rosenberg is supported by the National Institutes of Health (grants R01 CA222486 and R01 CA225629).

Disclaimer: The opinions presented in this manuscript are Dr Rosenberg’s and do not necessarily represent those of the National Institutes of Health. There are no original data presented in this essay; Dr Rosenberg takes responsibility for the interpretations of published data presented in the references.

References
1.
Southwick  SM , Bonanno  GA , Masten  AS , Panter-Brick  C , Yehuda  R .  Resilience definitions, theory, and challenges: interdisciplinary perspectives.   Eur J Psychotraumatol. 2014;5:5. doi:10.3402/ejpt.v5.25338PubMedGoogle ScholarCrossref
2.
American Psychological Association. Building your resilience. Published February 1, 2020. Accessed March 10, 2020. https://www.apa.org/topics/resilience
3.
Panter-Brick  C , Leckman  JF .  Editorial commentary: resilience in child development—interconnected pathways to wellbeing.   J Child Psychol Psychiatry. 2013;54(4):333-336. doi:10.1111/jcpp.12057PubMedGoogle ScholarCrossref
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