As someone who has always been curious about the mental health crisis in veterinary medicine, I wanted to learn more about the topic of “emotional resilience,” a term that I have only come across in a seminar in my first semester at vet school. Isn’t resilience a fixed trait that you are born with? A personality trait? Can you really “improve” your resilience?
On February 2nd, 2022, I attended a virtual emotional resilience training workshop hosted jointly by the British Small Animal Veterinary Association (BSAVA) and the RCVS Mind Matters Initiative. The workshop was practical, thought-provoking, and encouraged a safe space for those in the veterinary profession to share their experiences.
Throughout the three-hour training, Eddie, the workshop leader, explained risk factors and protective factors to being resilient, ways in which to recognise one’s own level of resilience, tools that we can use to improve our own emotional resilience, as well as how to help someone who may be struggling with their mental health.
The session started out discussing the symptoms of resilience. One thing that stood out to me was “chronic rumination”, namely, the act of replaying a negative experience over and over in your head. Have you ever had a bad experience that you keep flashing back to, haunting you and making you wish you had done something different? I definitely have. The reason why rumination is detrimental to one’s mental health is because it impairs one’s ability to process and “move on” from events that have occurred. This can quickly spiral into clinical depression, whereby a feedback loop of negative thoughts about the event leads to more negative thoughts about oneself or one’s circumstances.
Apparently, people who have higher resilience do not ruminate as much, and tend to move on from negative experiences a lot quicker than less resilient people. So, how do we stop ruminating?
Symptoms of Resilience
One way is to learn from people who are resilient, based on these lists of traits that psychologists have come up with.
Resilient people tend to:
Seek help
Be optimistic
Set goals
Have supportive family and friends
Have a sense of control
Have religious beliefs
Feel more positive emotions
Meanwhile, non-resilient people tend to:
Not ask for help
Be pessimistic
Feel loneliness
Have no goals or purpose in life
Have experienced trauma, stress, or illness
At first, it may seem that resilient people tend to have the luxury of growing up in a stable family with parental guardians who had a positive influence on the way that they see the world. For instance, someone who had grown up with an optimistic parent is more likely to learn that attitude of viewing the world, and in turn be an optimistic person themselves. Whereas someone whose parents always point out the absolute negatives of why something will “never” happen, or instead of just saying that they’ve failed, they call themselves a “failure”. In the workshop, attendees were prompted to find out whether they were an optimist or pessimist using this optimism test developed by UPenn.
The below illustration shows that the balance between risk and resilience determines whether one falls into the “safety” or “depression” zone. While one’s circumstances may predetermine their risk or protection from either zone, resilience is the key factor that one can learn to manipulate to be proactive in maintaining their mental wellbeing.
(Adapted from BSAVA Emotional Resilience Skills, Bannan 2022)
When Lack of Resilience turns into Clinical Depression
In some cases, a lack of resilience can lead to clinical depression. This happens when the ability to bounce back, or to recover from stressful or traumatic events decline. Consequently, feelings of helplessness, hopelessness and worthlessness begin to emerge, and when these feelings do persist for at least two weeks, one is diagnosed as clinically depressed.
Four changes that occur to people who have become depressed include behavioural changes, such as becoming more passive, indecisive, having a lack of goals, and easily giving up; emotional, whereby there are prolonged feelings of sadness and despair; physical, such as disrupted sleep and unhealthy change in eating habits, as well as cognitive changes, marked by negative thoughts about yourself, others, and the world, alongside impaired memory and learning.
Recognise the signs
If you recognise some of these negative feelings in your daily life, seek to interrupt this destructive cycle of negative thoughts. In the workshop, I learned to that one should think more optimistically - instead of explaining that an event occurred due to a permanent reason, especially a reason that you cannot change, think objectively about why the event occurred. For example, instead of thinking I failed this exam because I am not as smart as everyone else, think: I failed this exam because I didn’t study hard enough, which provides you with the option of studying harder next time to pass. In this way, you will start to feel less hopeless and more hopeful, with a simple shift in the way that you approach adversity.
An easy acronym, ABCD, can help you remember how to evaluate stresses:
Adversity - what stressful event am I facing?
Beliefs - am I being pessimistic or optimistic?
Consequences - what is the impact of the adversity?
Dispute your beliefs with evidence - is the way that I am evaluating the adversity appropriate based on evidence?
Mental Health and One Health
Another surprising fact that I learned was that when one is clinically depressed, this can actually impact one’s competence to practice. This is reflected by a temporary decrease of IQ by 30 points, as well as the tendency to make more irrational, emotional and often negative decisions than usual. What a perfect example of One Health in relation to mental health - veterinarians and medical professionals’ mental health is intricately connected to the quality of medicine that they would be able to practice, and thus impacting the health of their human and animal patients. This is why it’s particularly important to raise awareness within healthcare workers about mental illnesses and provide resources for them to seek help when needed.
Steps Towards Healing
Step One: Identify the signs. Sometimes, the person may come to you telling you that they are distressed, but even then it can be dismissed as “feelings” instead of a mental crisis. Other times, we have to be more proactive in initiating conversations with those who may not be as open to asking for help.
Some signs to look for include in someone who may be depressed:
Always upset
Not engaging with other people
Reaction is negative
Not sleeping
Memory is impaired
Academic/job performance plummets
They tell you they are distressed
Step Two: Listen and ask. During my first semester of vet school, I’ve heard about active listening when communicating with clients, but what is it really? From this workshop, a simple schematic helped me remember that it is simply a loop of asking an open-ended question, then letting the other person talk with no interruption, and then use what they say to trigger your next question. This allows the person to not feel judged and a chance for them to tell you what is really going on in their lives whilst avoiding the feeling of judgement.
The way one asks questions can also influence the quality of response one receives. In an exercise during the workshop, the attendees were asked to ask two questions in order to guess a famous person. Instinctually, a volunteer asked, “is the person male or female?”. However, this is an example of asking deductive questions rather than open-ended ones. Applying this to a real-life scenario, instead of asking someone “are you feeling better?”, a better question to ask would be “How are you feeling?”. The latter question will yield a much more holistic and detailed answer rather than a simple yes or no.
Step Three: Link. After determining that a loved one is struggling with their mental health, one can then help them engage in a doctor, VetLife helpline, or an employer to discuss their situation. This ensures that the person is receiving the support that they need, while taking on the role of a supportive friend or relative and leaving the consulting to trained professionals. On top of that, it is also a good idea to check in on the depressed person’s family and friends, as it is likely that they are also affected. I would personally add that it is important to check on your own mental health.
Overall, this workshop made me reflect on the importance of training my own mental resilience, particularly when stepping into the veterinary field. It provided me with different ways to respond to adversity, and also helped me identify signs in my peers and future colleagues so that I can better aid them when needed.
The next emotional resilience talk will be held on Wednesday, March 2nd at 10am-1pm. This event and many others by BSAVA are free for students. If you are interested in learning more, I would highly recommend you to tune in!
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