Teaching Resiliency to Help Health Care Professionals Cope: Q&A with Daphne J. Holt, MD, PhD

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The COVID-19 pandemic has people feeling isolated and overwhelmed by the new challenges they are facing in their daily lives. The same is true for essential health care workers including doctors, nurses, administrators and staff who have the added fear of COVID exposure either on the way to work or at the job while managing the stress of caring for patients.

In this Q&A, Daphne J. Holt, MD, PhD, physician investigator in the Department of Psychiatry at Massachusetts General Hospital, teaches skills for dealing with the overwhelming stress on health care workers during the pandemic and discusses how learning resiliency through online training can help them manage their mental health during this stressful time.

Q: How do you define resiliency?

Holt: Resiliency is the ability to manage the stress in one's life, including highly stressful life events such as the COVID-19 pandemic and all of its consequences in our lives. The concept also includes the idea that sometimes we can grow and develop new coping skills during stressful times, if the stress is not too overwhelming.

There are certain abilities that have been linked to resilience, including being able to think flexibly about situations and the ability to manage one's emotional reactions by not avoiding, suppressing or acting too quickly on them. Also, the ability to connect with others in an authentic way can be protective. Some of these abilities can be improved with practice.

Q: What mental health problems have arisen for health care workers during the pandemic that resiliency training can help?

Holt: Frontline health care workers are suffering from elevated rates of depression, anxiety and insomnia during this pandemic, which has been the case during previous epidemics as well. There have been a number of studies, including several that were conducted at Mass General this past summer, that show that learning resilience-boosting techniques can reduce emotional distress in frontline health care workers.

Q: How do you teach resiliency to health care providers?

Holt: Techniques for learning resiliency skills are somewhat universal in that the skills most helpful for health care providers are also helpful for many people. But there are certain types of stress that clinicians may experience more than others, particularly during health care crises like the coronavirus pandemic.

For example, health care providers are often very hard-working people who can be perfectionists at times—many providers are understandably distressed when they are not able to help a patient, or when they make a mistake, however small. This trait seems like a good thing for all of us receiving health care, but the reality is that there are many things we cannot control about this pandemic and the health care system in general.

If a provider suffers every time things don't go well, that can be very hard and ultimately make it difficult to continue to have enough energy to do one's job. Also, it's been shown that people who are very hard on themselves when they make mistakes do not necessarily perform better at their jobs than those who are less demanding of themselves. Self-criticism can consume a lot of energy. So trying to combat it with what we call "self-compassion" is one skill we focus on with health care workers.

We also work on a capacity called "mentalization," which is the ability to understand the mental states of other people, since it's been shown that caretakers who have a greater ability to understand the perspectives of the people they're taking care of have better mental health and less burnout. These are just some of the things we work on in our resilience courses.

Q: How is resiliency training given today?

Holt: Resilience training can be given in a number of ways—via mindfulness apps, online courses (for example, our three-session online course), courses or workshops delivered via videoconferencing.

Also, we are now beginning to offer a virtual reality (VR)-based resilience training course in a research study. The advantage of this virtual approach is that VR can provide a nice sense of being physically together, in the same virtual "room." Also, since everyone who attends a VR-based workshop is doing so as a virtual character (as an avatar), health care providers can attend without revealing their identities—if they choose to—maintaining their privacy.

Q: Are there any examples of successful resiliency learning?

Holt: During this past summer, 66 Mass General Brigham employees who took an online resilience course experienced significant improvements in their mental health afterwards—increases in resilience and decreased symptoms of anxiety and depression—when compared to employees who did not take these courses.

Also, 102 health care providers who participated in a mind-body stress management program that consisted of eight live Zoom sessions with groups of providers, showed significant improvements in resilience, mindfulness and self-compassion, and reductions in emotional distress and loneliness.

Q: When should a health professional reach out for clinical help and what resources are available to them?

Holt: As with any time, when painful feelings and emotional distress become persistent or start to interfere with one's ability to do tasks that are normally pretty easy to do, it's important to think about getting help. It's better to ask for help before these feelings become overwhelming and debilitating.

There are many sources of mental health care in the Mass General Brigham system for employees including referrals from one's primary care physician, the self-service resource section, the Psychiatry Clinician Access for Referrals & Employee Support (Psychiatry CARES) Clinic (617-724-7150) and the Employees Assistance Program (EAP). EAP staff can also provide additional information about a range of local mental health resources that might be helpful for addressing each employee's needs.

Our department's philosophy has always been that you should "never worry alone"—it's important for everyone to know that there is support available here when you need it.

Learn more about the Department of Psychiatry at Mass General

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