Resilience and coping skills – the flip side of PTSD and mental health adversity

With the annual Armistice Day commemorations and this year’s World War One centenary, the fate of the men and women who served their country comes under renewed scrutiny and a close look reveals a surprising phenomenon relevant to today’s mental health discussion and particularly PTSD.

There are some important mental health lessons for us all within this subject. First, let me introduce you to Jim Stockdale – a Vietnam War pilot who was shot down in 1965 and held captive for several years in the infamous Hanoi Hilton.

During this time, Stockdale was mistreated and had little chance of rescue – his situation was very grim but he made the most of what little he had.

On September 9, 1965, at the age of 40, Stockdale, who was the Commanding Officer, VF51 and Carrier Air Group Commander (CAG-16), was catapulted from the deck of the USS Oriskany for what would be the final mission. While returning from the target area, his A-4 Skyhawk was hit by anti-aircraft fire.

He emerged from the experience in 1973 relatively unscathed and went on to have a successful career in the military, even running for Vice-President in the early 90s. When asked about how his POW experience had helped shape him, he explained:

“I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event of my life, which, in retrospect, I would not trade.”

Whilst Stockdale managed to retain what might loosely be described as realistic optimism over his situation and was resilient, others didn’t fare so well.

Regarding those who didn’t make it out in such great shape, he noted: “They were the ones who said, ‘We’re going to be out by Christmas.’ And Christmas would come, and Christmas would go.

Then they’d say, ‘We’re going to be out by Easter.’ And Easter would come, and Easter would go. And then Thanksgiving, and then it would be Christmas again. And they died of a broken heart.”

This story is illustrative of many brave people for whom an extreme experience, such as being held captive or fighting in a war, is, as Stockdale describes it, “the defining event of my life”.

They can’t alter the fact that they’re in that situation, so maintaining perspective and looking at the bigger picture or long-term scenario is the only way to emerge from such an experience with the best possible mental health.

In a nutshell, Stockdale developed and maintained enormous reserves of resilience (“I never doubted not only that I would get out, but also that I would prevail in the end…”) and it is this which is likely to have been a major factor in overcoming the situation and going on to live a successful life.

So how does this translate into useful lessons for those interested in mental health today?

Adversity breeds resilience, so it’s a useful exercise to think about things you’ve also overcome that might not be as extreme but could be no less important in your life – for example, the birth of a child is a moment many cite as being terrifying but also life changing in a positive way.

Work, personal life and sports all provide lots of opportunities to build resilience and develop helpful coping skills, all the time adding to that body of evidence in our mind that we can do this and we can cope.

Whatever your background, nearly everyone has experienced adversity, and if you’re reading this right now than you’ve successfully survived all that life has to throw at you so far. Take time to process these victories and you’ll be adding crucial foundations to your mental health and building that all-important resilience – “you can cope with this situation”, the voice in your head should be saying when you face adversity.  

Not everyone enters or emerges from a very negative situation with such a set of skills, however, and the epidemic of PTSD (Post Traumatic Stress Disorder) amongst veterans and other survivors is illustrative of the huge mental health cost some pay.

PTSD is defined by the American Psychiatric Association as: A psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people.

People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

They also offer the following surprising statistic: “PTSD affects approximately 3.5 percent of U.S. adults, and an estimated one in 11 people will be diagnosed PTSD in their lifetime. Women are twice as likely as men to have PTSD.”

With such a widespread problem, it’d be easy to assume that treatment for PTSD is easily available and effective. Actually, like lots of mental health issues, PTSD is remarkably badly served by the medical community and the go-to treatments for many are our old friends, ineffective SSRI antidepressants and ropey CBT, with some Eye Movement Desensitization throw in for good measure (nobody knows how EMD works and it’s been criticised by many as being no better than a placebo)

All have, at the least, questionable track records in helping people overcome long-term mental health issues such as PTSD and they’re described by many as sticking plaster treatments that don’t address the root of the issue.

So what does work for someone struggling with PTSD? In a word, education. By learning how their PTSD works – how their past experiences are being processed through the prism of their thoughts and emotions and how they can manage this effectively – just about anyone can gain control of their mental health.

Think about it this way: if you understand how a part of your body works, an arm muscle for example, then you can do exercises to strengthen and train that muscle. But if you don’t know how that muscle works, you’re just guessing how it can be improved.

Instead of targeted dumbbell curls to make your biceps bigger, you’d be doing all sorts of arm exercises in the hope that one made a difference. This is how lots of organisations approach mental health treatment – throw enough pills and therapy at a problem and maybe one will work, eventually.

Front line personnel such as Armed Response Unit police officers have high rates of PTSD and stress – coping skills and resilience are vital to ensure good mental health

The difference between offering a PTSD sufferer outdated treatments such as CBT (or, in some cases CPT – Cognitive Processing Therapy, a variant of CBT) is best summed up by serving Met Police offer and Armed Response Unit commander Andy:

“I have been a police officer for almost 20 years and an Operational Firearms Commander for the last 10 years within the Armed Response Unit.

Throughout my service I suffered from stress due to the ongoing rigours of the job mixed with issues in my personal life. I completed the Thrive Programme and learned how my mind was interacting to create my symptoms.

I discovered that it was my overall feeling of having no power or control in my life that was the main driver for my stress reactions. After completing The Thrive Programme I felt more in control and was able to use the skills I learnt during the course of my daily duties.

I have directed some colleagues to The Thrive Programme and it has relieved symptoms in a few weeks where they had previously received other treatments for months and even years.”

Interestingly, Andy makes a very similar statement to Jim Stockdale’s comments about overcoming adversity: “I now have lasting tools to deal with anything that life or the job throws at me…”

Clearly, Andy feels he now has resilience and coping skills in relation to PTSD and stress reactions to his job, just as Stockdale did when dealing with his imprisonment.

The parallels teach us that, whilst not everyone can go into an adverse situation with the tools to come out smiling, those tools can be taught and used for a similar end effect.

In short, anyone can learn how to overcome and cope with adversity and this is important because PTSD kills and many of these deaths are avoidable.

Imagine if every soldier and police officer was equipped with the same mental health skills that policeman Andy and Jim Stockdale learnt and developed – they’d be much more likely to emerge from adversity intact and mentally healthy, which would be likely to have a huge impact on suicide rates and PTSD rates.