1. Harpham, Wendy S. MD, FACP

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Resilience helps patients through and beyond cancer treatment. This handout encourages patients to think about resilience in new ways and take steps to build resilience.

Wendy S. Harpham, MD... - Click to enlarge in new windowWendy S. Harpham, MD, FACP. WENDY S. HARPHAM, MD, FACP, is an internist, cancer survivor, and author. Her books include

Maximizing Your Resilience

Dear Patient,


Emotional resilience helps you through treatment and recovery. This handout is designed to help us work together to optimize your resilience.


What is emotional resilience?

Resilience is defined as the ability to recover from difficulties or, as people often say, bounce back. Here's a different definition, one well-suited to cancer survivorship: The ability to 1) adjust to unwanted change, 2) live for today, and 3) hope for a better tomorrow.


What's wrong with wanting to "bounce back"?

Nothing, if that phrase inspires you. Problems can arise if the notion of bouncing back leads you to unrealistic goals. Survivorship often involves setbacks and slow recoveries, even if things are going well overall. Expecting or hoping to bounce back easily and quickly may stir anger, frustration, disappointment, confusion, or loss of confidence. Some patients blame themselves or others, which adds stress to an already challenging time.


What determines your resilience?

Your ability to recover from illness depends on many factors, only some of which we can predict or control. For example, all other things being equal, you can expect to show more resilience (i.e., recover more easily) after completing mild treatment compared to harsh treatment. A list of other factors that may build or weaken resilience includes your...


* Past experiences with challenges


* Personality and general outlook


* Stresses (cancer-related, or not)


* Support system


* Spiritual faith


* Hope



Can you build resilience?

Yes! Together we can address medical issues that may weaken your resilience. Regardless of your prognosis, we may recommend consulting a palliative care specialist to help us address symptoms causing discomforts and distress.


We also can refer you to resources and services that help patients build resilience. As with other life challenges, many patients use the unwanted cancer experience to grow stronger in certain ways. Keep in mind, patients usually feel weaker and more vulnerable before they begin to feel stronger.


How does brain chemistry affect resilience?

Thoughts and feelings arise in your brain. Changes in brain chemistry may affect resilience by making it difficult to think and act like your usual self. Factors that can negatively impact brain chemistry include the following:


* Medications (prescription and over-the-counter)


* Inadequate or poor-quality sleep (difficulty falling asleep or staying asleep, nightmares, awakening to go the bathroom)


* Chronic stress


* Pain, including minor discomforts that seem tolerable in the short run


* Fatigue


* Poor nutrition


* Emotions, such as anxiety and grief



What can you do to improve the chemistry of the brain?

The good news is we can improve the chemistry of the brain. Healing interventions depend on your candidly keeping us informed about pain, fatigue, stress, and the other issues listed above. Working together during and after treatment, we can minimize the impact of resilience-depleting factors.


Sometimes altered brain chemistry needs a short course of anti-anxiety or anti-depression medications. It's not a sign of weakness to help your body by taking such medications. It shows you're doing what you need to do to think, feel, and act more like your usual self.


How does your ability to adjust to changes affect resilience?

By adjusting to changes, you make life easier. You know what to expect and the best ways to do things. That conserves your physical and emotional energy, leaving you with more energy-resilience-to handle challenges and get on with life.


Learning to adjust takes time and effort. Steps that may help include...


* Learning what to expect (from us and other reliable sources)


* Talking with well-adjusted survivors who can offer insights and tips


* Working with a professional in rehabilitation (e.g., a counselor, physical therapist, fitness trainer, nutritionist)


* Journaling about your survivorship


* Keeping a gratitude journal



Obtaining guidance and support from allied health professionals helps you tap into your strengths and overcome obstacles. Working with experts helps minimize the chance of ever looking back with regret, saying, "I wish I knew then what I know now."


Journaling about your survivorship is a tool that helps you understand your challenges, set goals, and nourish hope. It provides a private place to express your emotions, so you can then use them positively and/or let them go. Journaling also helps you see progress, especially since progress can be too slow to appreciate from week to week. A gratitude journal sensitizes you to the little and big joys in your life that otherwise might be overshadowed by the stresses of illness and recovery.


How might counseling help build your resilience?

A few sessions with a counselor may help you do your best when facing the challenges of cancer, much the way trainers help elite athletes perform their best.


Social workers, psychologists, and clergy offer a safe place to talk about difficult emotions and benefit from their expertise and insights about overcoming personal challenges.


Counselors also can refer you to services that may help, such as support groups, yoga or mindfulness classes, nutrition classes, and useful reading lists.


How does hope build resilience?

Hope plays a major role in resilience. Hope motivates you to act when you can do something to improve the outcome (see our handout on Healing Hopes). Hope also helps you wait while you're doing all you can-or when there's nothing you can do.