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Update from Dr. Aw

March 23, 2021

Emotional resilience and bouncing back from adversity ​​​​​​​

Dealing with this pandemic has been a marathon on our physical, mental and emotional well-being. I’ve been listening to patients and colleagues in my medical practice go through a rollercoaster of ups and downs dealing with the uncertainty, anxiety, stress, COVID burnout.

As a physician, sometimes it feels like I’m supposed to have all the answers. But we are all struggling with our well-being. In fact, amid the pandemic, an American and Scandinavian study was done on surgical residents. It found that there were significant barriers in the profession to using well-being resources, but there are ways to introduce tools. Key components of an effective and holistic well-being program provided training in:

  • emotional (mindfulness-based affective) regulation skills

  • advance scheduling of time off

  • attention to work quality (vs. quantity)

  • ability to address inefficient systems in a psychologically safe workplace

We must check in with ourselves, be kind to ourselves and recognize what we need to get through this difficult time. Hey, we’re all human. We’ll have good days and bad days, grumpy days and happy days — and that’s okay.

As we collectively shift our focus on trying to adapt to living with the virus, resilience is an important topic.

What is resilience?

I’ve noticed resiliency is an attribute recognizable when individuals display the following characteristics or behaviours:

  • Exuding highly positive emotions

  • Acceptance or non-reactivity to stressors

  • Connectedness or high social support

  • Establishing healthy daily routines and good habits

  • A sense of control

  • A gratitude mindset

It seems that the most important factor in resiliency is having strong and supportive relationships within and outside the family.​​​​​​​

​​​​​​​According to the American Psychological Association the other factors that are associated with resiliency include:

  • The capacity to make realistic plans and take steps to carry them out.

  • A positive view of yourself and confidence in your strengths and abilities.

  • Skills in communication and problem solving.

  • The capacity to manage strong feelings and impulses.

“The greatest glory in living lies not in never falling, but in rising every time we fall.”
— Nelson Mandela


(noun) re-sil-ience

"...the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors."

"It means 'bouncing back' from difficult experiences."

Source: American Psychological Association

How do we develop our emotional resilience? ​​​​​​​

Studies have looked at the emotional response to failure as a factor that can help improve resilience. High emotional resilience was associated with higher self-esteem, positive attributional style (optimistic view) and lower sense of perfectionism. Perfectionism can fuel a sense of always being too hard on yourself and setting unrealistic expectations in a complex changing world. It’s OK — and liberating — to not be perfect!

Emotional resilience is also linked to having a clear sense of purpose and meaning in your life. The Japanese have a saying called “IKIGAI” which is daily reminder of one’s reason for being and why we get out of bed in the morning. A clear sense of purpose can fuel optimism!

​​​​​​​​​​​​​​And lastly, the little things can help. I have gotten through this pandemic with coffee, Spotify and good books! I am currently reading a book called “Keep Sharp. Build a Better Brain at Any Age.” by Dr. Sanjay Gupta, CNN Chief Medical Correspondent and neurosurgeon. I was fortunate to meet him years ago at a Toronto hospital fundraiser and always appreciated his medical journalism. Dr. Gupta reports on the concept of cognitive reserve: Emotional resilience isn’t just behavioural. You also need to nourish the brain. Brain resiliency improves with a predisposition to lifelong learning (from past experiences), education (something new) and curiosity. As they say – “Use it or lose it.” His five pillars of brain health are Move, Discover, Relax, Nourish and Connect.

Four circles overlapping each other with Ikigai in the middle, surrounding Ikigai is: what you love, mission, what the world needs, vocation, what you can be paid for, profession, what you are good at, passion.

Take action — Here are a few resources to help you address your emotional resilience.

Learn from these tips:

I encourage you to check out the tips the American Psychological Association posted on 10 Ways to Build Resilience:

  1. Make connections.

  2. Avoid seeing crises as insurmountable problems.

  3. Accept that change is a part of living.

  4. Move toward your goals.

  5. Take decisive actions.

  6. Look for opportunities for self-discovery.

  7. Nurture a positive view of yourself.

  8. Keep things in perspective.

  9. Maintain a hopeful outlook.

  10. Take care of yourself.

Personalize your wellness:

You may benefit from taking your own wellbeing measurement to assess your current emotional health. Check out these:

  1. Maslach Burnout Inventory Self-Test

  2. Cohen Perceived Stress Scale (measure of stress for men and women aged 18-34)

  3. Patient Health Questionnaire (depression screening tool)

  4. Alcohol Use Disorders Identification Test (World Health Organization)

  5. Spielberger State-Anxiety Index (subjective feelings, arousal correlated to anxiety to trauma)

  6. Cognitive Affective Mindfulness Scale [attention to one’s thoughts, feelings and sensations), present focus, open awareness, acceptance]

  7. Mental Health Continuum-Short Form (individual social, emotional and psychological well-being)

  8. Demand Control Support Questionnaire (job strain for psychological demand, control, social support)

Emotional resilience is a personal journey and iterative process of trying, failing, adapting and evolving.  Life’s experiences  — happy and sad — teach us how to cope with adversity in our own personal way.  Winston Churchill famously said, “Success is not final, failure is not fatal: It is the courage to continue that counts.”


  1. Fredrickson  BL.  The Broaden-and-Build theory of positive emotions. Philos Trans R Soc Lond B Biol Sci. 2004;359(1449):1367-1378. doi: 10.1098/rstb.2004.1512PubMedGoogle ScholarCrossref

  2. Masten  AS.  Ordinary magic: resilience processes in development. Am Psychol. 2001;56(3):227-238. doi: 10.1037/0003-066X.56.3.227PubMedGoogle ScholarCrossref

  3. Exploration of Individual and System-Level Well-being Initiatives at an Academic Surgical Residency Program A Mixed-Methods Study

  4. Personal and work-related factors associated with nurse resilience: A systematic review

  5. Resilience to emotional distress in response to failure, error or mistakes: A systematic review

  6. American Psychology Association.  Resilience curing the COVID-19 Pandemic. 10 Ways to Build Resilience.

  7. Resilience Guide for Parents and Teachers.

  8. Emotional Resilience Self Assessment

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