A Commentary: Rethinking approaches to Resilience and Mental Health Training

M. Crane, D. Boga

Abstract
While exposure to demands are normally considered to drain resources and threaten wellbeing, some people experience growth and development from adversity that fosters adaptations in human functioning. Recent research has revealed a positive role for adversity in building the ability to adapt well to future adversity. However, how and why adversity functions to facilitate resilience in some people is an empirical question. We propose that systematic self-reflection is an important strategy for facilitating resilience as a consequence of stressor exposure. The systematic self-reflection model of resilience building, presented in this paper, is a new approach to military resilience training intended to complement existing training methods that focus on the enhancement of adaptive coping used in the Australian Defence Force.

Keywords: resilience training, coping, training transfer, self-reflection

Introduction
Despite the contribution that resilience training can make when implemented in the workplace1, there are limitations with approaches often used
in militaries across the world as well as in other organisations keen to promote resilience in their employees. Increasing one’s coping repertoire,
while also reducing problematic coping styles (e.g., avoidance and thought suppression) is often a core part of training2,3. For example, the Directorate of Strategic and Operational Mental Health within the Commonwealth Department of Defence has capitalised on key insights from the transactional model of stress and coping4 and Cognitive- Behavioural Therapy to create the BattleSMART training package. In this way, the BattleSMART program is faithful to two robust and well researched approaches to mental health and adaptive coping. Yet, training regarding when to use particular coping strategies allowing for the selection of situationappropriate coping is often neglected in approaches to resilience training. A good-fit between coping and the nature of the stressors is referred to as coping flexibility and is understood to be critical to handling a diversity of stressful encounters and to resilient functioning5. Moreover, for training recipients there are often significant barriers to the successful modification of maladaptive coping. It is often distressing, or at least uncomfortable, for an individual to change their use of avoidance coping to a more adaptive style of coping because stressors are perceived to be threatening. This reluctance limits the transfer of training to actual stressor situations.

A new approach: Systematic self-reflection

The proposed approach addresses the above limitations and is intended to complement resilience training that emphasises the teaching of adaptive
coping strategies. Encouraging specific systematic self-reflection practices, as part of resilience training, can enhance the individual’s insight
into their coping and its effectiveness in different contexts increasing the use of situation-appropriate coping. Moreover, systematic self-reflection practices encourage the training participant to view stressors as an opportunity for building resilience and personal growth.

Systematic self-reflection is a practice considered to be essential to developing behavioural practices and has been identified as an important training tool6. Loughran (1996)6 defined reflection as ‘the deliberate and purposeful act of thinking, which centres on ways of responding to problem situations’ (p. 14). Thus, reflection is a process of self-inquiry and enables an individual to make decisions about what are effective and desirable behaviours in a given demanding situation. Ellis, Carette, Anseel et al. (2014)7 have shown the important role of systematic self-reflection in helping people to learn from their successes and failures. Although exposure to demands are normally considered to drain resources and threaten wellbeing, some people experience growth and development from stressful experiences that foster adaptations in human functioning8. Recent research has revealed a positive role for adversity in developing the ability to adapt well to future adversity8. We propose that systematic selfreflection
on the application of coping is an important strategy for facilitating resilience as a consequence of stressor exposure. The systematic self-reflection
model of resilience building (Figure 1) proposes that resilience can be developed as a consequence of stressor exposure because stressors provide a
context that allows the application and refinement of coping strategies. Our model is complementary to, but unique from, approaches to resilience that emphasise the role of important social (e.g., social support) or psychological resources (e.g., optimism)9. Systematic self-reflection on coping is a process that is intended to complement the use of adaptive social and psychological resources by reinforcing their application and reducing the use of maladaptive strategies. Therefore, social and psychological resources are an important foundation to systematic self-reflection.

For systematic self-reflection to be useful in the context of developing resilience it needs to involve specific cognitive practices. Figure 1 illustrates five reflective practices that are considered important for the development of resilience as a consequence of stressor exposure. First, recollection of critical incidents involves a brief description of the incident and behavioural, physical, cognitive and emotional response to events. This practice is intended to help the individual notice the presence of maladaptive coping, or the application of adaptive behaviours (e.g., support seeking) and thinking styles (e.g., optimism) defined by previous models of resilience9. Second, coping values and goals requires the individual to consider how they would ideally respond under pressure and what personal goals and values this represents. Third, evaluation of effectiveness is an examination of whether the initial coping strategies were useful in attaining the valued coping. Fourth, analysis of why/why not effective requires the individual to consider why his/her response was more or less effective in allowing the achievement of valued coping. Finally, approach to future stressors
involves the development of a strategy for managing similar future stressors based on the assessment of past strategies. These five practices are intended to enhance: (1) coping flexibility, (2) situationappropriate coping, and (3) perceptions of stressors as opportunities for resilience building. In turn, these practices will lead to the development of greater resilience.

There is a necessity for reflection to be followed by further testing of coping styles in response to stressors and further adjustment where necessary.
This feedback process is illustrated in Figure 2. According to Schön (1983)10 reflection-in-action acknowledges the importance that thinking is
accompanied by doing, which allows application and then the modification of practices so that discovery and learning can occur. BattleSMART does go some way to addressing this by asking participants to test the appropriateness of coping strategies and adjust their strategies accordingly. This is referred to as test and adjust in the BattleSMART model2. However, it is this critical piece that needs to be emphasised, elaborated, and practiced in situ.

The systematic self-reflection process may initially seem reminiscent of critical incident debriefing which has received mixed support11. However, while debriefing usually occurs after exposure to potentially traumatic events, systematic self-reflection is encouraged after the onset of all stressors. In fact, less significant adversities are likely to be a good opportunity to begin refining one’s approach to coping because the nature of the stressor is less aversive providing an opportunity to engage in elaborative self-reflection. Moreover, debriefing practices focus on the management of distress and preventing the later onset of mental illness11. The focus of the systematic self-reflection is on the use of adversity as a growth opportunity and the formalised analysis of coping effectiveness.

Systematic self-reflection and adversity as an opportunity for resilience-building

Engaging in self-reflection of this type is also proposed to influence the motivational system in a way that encourages stressor engagement. The
term motivation is generally used to describe the forces that provide an incentive for people to initiate and persist at some form of behaviour leading to desired outcomes12. It is often difficult to motivate people to engage with events, thoughts or emotions that are considered to be inherently stressful or distressing. Self-determination theory12 describes different motivations for engaging in particular behaviours and delineates the existence of weaker from stronger psychological motivators. Weaker motivators are considered to be externally controlled and these reflect behaviours contingent on reward or punishment (external regulation) or those required to feel as sense of self-worth (introjected regulation). Stronger motivators are those that align the activity or desired behaviour with identified values, achievement or important goals, or because the activities are inherently enjoyable. Motivation derived from these aspects is referred to as autonomous motivation12. The systematic self-reflection process is intended to increase one’s autonomous motivation to engage with stressors by helping individuals to view stressors as an opportunity for resilience-building
and personal growth in-line with personal values and goals. In the context of the military, this allows resilience training to be readily aligned with meeting one’s desired performance goals, rather than the prevention of mental illness (which is perhaps not perceived as immediately important to personnel who are fit and well).

A strategy that can be implemented by leaders

The other critical aspect of systematic self-reflection is that it can be implemented by leaders, rather than exclusively by mental health practitioners. Leaders can be trained to facilitate systematic self-reflection after critical events and this is important for two reasons. First, the program will be more sustainable given that training administration is distributed across different personnel. Second, the development of resilience is integrated into daily work and training practices (e.g., post-activity reviews) facilitating training transfer and the integration of mental and physical aspects of  performance.

Conclusion
The purpose of this commentary was to present a process for building resilience as a consequence of exposure to stressors that can complement existing resilience training, both in the military and other organisations. At present, the strategy is conceptual and the authors encourage a formalised evaluation prior to broader application. However, we believe that self-reflection has the potential to increase the efficacy of resilience training by giving the individual tools to self-assess and improve their own coping and view stressor events as an opportunity for growth.