Why are some of us better at coping with tough times than others? Lucy Trevallion meets Claire, a heart patient who has learned skills for resilience.
An unexpected diagnosis, a sudden heart attack, or finding out that heart problems run in your family – these are just some of the difficult situations many of us will deal with. Some people will panic and feel overwhelmed, while others seem to face things calmly and recover quickly. Part of the answer to getting through these tough times may be resilience.
“Resilience is the ability to take the knocks, and carry on with your aims and ambitions and aspirations,” explains Professor Patrick Doherty, Chair of Cardiovascular Health at the University of York. “A heart attack or diagnosis of heart failure is a substantial blow to an individual’s confidence, their invincibility.”
Resilience involves internal and external factors. “Resilience is really complicated because it isn’t just about the context in which they find themselves. That includes deprivation, the people they have around them, carers, the conditions they’ve had prior to the actual heart problem, their psychological state, risk factors and physical state.”
Age isn’t a barrier, says Professor Doherty. “Do not think you’re too old to be resilient. That’s clearly not the case, it’s been proven in all of our data.” His research concerns cardiac rehabilitation – looking at what determines whether people take up the programme, and how good their outcomes are.
Personal characteristics play a part in how resilient you are. “It’s that positive outlook you see in some patients,” says Professor Doherty. “They see themselves as one of the lucky ones that survived, rather than thinking: ‘I’m one of the unlucky ones because I had a heart attack, I can’t do what I used to do’. It’s a love of life, and moving forward as a consequence of that.”
Resilience is partly genetic and partly environmental but can also be learned, research has shown. A well-known study followed children in Hawaii, from their birth in 1955 to age 40. It found that a third of children from particularly adverse backgrounds did very well in their lives; the researchers called them “the vulnerable, but invincible”.
The “invincible” children had a mix of reasoning ability (which helped them find rational answers to problems), confidence in their own capabilities and a positive outlook. Later research found other behaviours that can help build resilience are: trying to avoid negative thinking, trusting in yourself, and seizing opportunities that come your way.
Since being diagnosed with heart failure, Claire Marie Berouche finds it difficult to walk, climb stairs, cook and, on some days, even get out of bed. Her diagnosis made her feel “cheated and very angry”, but she has learned to adapt.
Claire, 49, from west London, was leaving the cinema when she suddenly felt sick. She went home to bed where she stayed for three days, feeling nauseous and unable to eat or drink. As she has diabetes, her husband was concerned and called an ambulance.
When it arrived, Claire was feeling a bit better, sitting up in bed and chatting with the paramedics, but they did an ECG test as a precaution. “The paramedic suddenly looked at me with complete disbelief,” says Claire. “I was having a heart attack. She yelled to her colleagues: ‘Call in a code blue.’ It didn’t seem real.”
I felt like hope was taken away
Claire had an angioplasty procedure, followed by bypass surgery two months later. But recovery was slow, and during the fifth week of her cardiac rehab course, she felt something wasn’t right. “I insisted that I needed to see the cardiologist,” she says. “Three months later, I was diagnosed with heart failure.”
This means that Claire’s heart isn’t pumping properly, causing tiredness, shortness of breath and reduced ability to exercise. “In some ways that was worse than being told about my heart attack,” she says. “I felt like hope was taken away.”
Dealing with change
Before her diagnosis, Claire says she was a very confident, outgoing person. “I was a customer service manager so I was dealing with people and different situations all the time,” she says. Now, she can’t even stand up for too long. “I can go and meet friends for coffee, but it all has to be planned well in advance. I have to know where I’m going. Can I park my car right outside because I can’t walk any distance? When I get there, are the toilets on the same floor? Is there disabled access for my wheelchair? It takes so much effort that I don’t go out much.”
Writing it down on paper is getting it out of your system
But she is learning to live with, and accept, “the new Claire”. One way she has adapted is by finding gentler activities to replace those she did before. She found writing helps her deal with her emotions. “It’s about taking control, and writing it down on paper is getting it out of your system,” she says. “The new me is basically writing, colouring, quizzes and cross stitch!”
She also uses Facebook and internet groups to chat and get support from people who are in similar situations. She says communicating with people who aren’t as close to her can be easier, especially when they can relate. “My husband has been my rock, he really has,” she says. “But even now there are things that I just can’t discuss with him; it’s too raw.”
Benefits of resilience
Professor Doherty’s research found that having support or a carer could make it easier for people to make choices and put those choices into practice. This support is particularly important for those with multiple conditions. During the current coronavirus lockdown the BHF online community can be an alternative source of this support.
Claire has learned resilience – and there is evidence that difficult situations can make you more resilient for the future. A 2011 research project from the University at Buffalo, USA, found the silver lining of facing adversity was that it helped make people tougher. Dr Mark Seery, who led the research, says: “Toughness results in psychological and physiological changes that make people more likely to perceive stressful situations as manageable (rather than overwhelming) and to cope effectively with them… there is no opportunity for toughness to develop if someone has never coped with stress.”
But when it comes to daily life, Claire finds that focusing on the bigger picture can be overwhelming. “You have to try and look at the little things,” she says. “Find small things to motivate yourself.
“Find something good to focus on, and no matter how bad you think you have it, you will always find somebody who is far worse off than you. Stop and think: ‘OK, things aren’t great, they’re not as good as they were, but compared to some, I’m bloody fantastic!’”
Claire’s tips for staying positive
1. Get support when you need it
Speak to a loved one, or find support from an online group.
2. Take a positive from every day
Find one accomplishment each day, even if it’s something small, and give yourself credit for it. Sometimes I haven’t managed to get dressed or brush my hair, but I say to myself: ‘The positive is, I have actually managed to get myself out of bed.’
3. Feel grateful for the things you have
A safe place to live, loved ones: there’s always something to be grateful for. Try writing it down. There’s evidence keeping a gratitude journal positively affects wellbeing.
4. Find hobbies that suit the new you
Try writing, colouring or quizzes if you need to spend more time in bed or sitting down.
5. Never give up hope
You get to a point where you’re as low as you can get, and then you just have to claw yourself back. You have to fight back.