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April 14, 2020

Cultivating Deliberate Resilience During the Coronavirus Disease 2019 Pandemic

Author Affiliations
  • 1Department of Pediatrics, University of Washington School of Medicine, Seattle
  • 2Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
JAMA Pediatr. Published online April 14, 2020. doi:10.1001/jamapediatrics.2020.1436

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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    3 Comments for this article
    Very Useful, Comforting Article
    I think that the most important word in your article is "deliberate", something one chooses to do, even in the face of adversity, trauma, or grief. For an action or a response to be deliberate though, there has to be a choice. The future narrative as you propose it may have several different developments and endings. So, reading you I have gained new insights into the difficulties we face in poorer settings when trying to observe self-isolation: the powerlessness that has been acquired through generations of failure to thrive keeps us from seeing the different narratives! Thanks for sharing your thoughts, I hope what I have learned will help me in my work in these dark days.
    Yes--Resilience is a Skill We Can Cultivate
    David Fessell, MD | University of Michigan
    Thank you Dr. Abby Rosenberg! Yes--resilience has been a field of study for over 50 years. It's very clear that resilience is a skill we can cultivate. Great categories, and yes, we can all help--directly with patients, or in "communities disproportionately affected" by coronavirus--right on! Together we can lift each other up and build our resilience skills.
    CONFLICT OF INTEREST: I have received honoraria for speaking on the topic of resilience.
    Dr Josphat Kagema, PHD | Karatina University, Kenya
    Thank you Prof. Rosenberg for this insightful article exploring the convergence of demystifying resilience in wake of this pandemic. My current research interest is exploring community resilience in Kenya. Thank you.