Transcript from Edge Talk on Resilience

KATE POUND: Good morning everybody, welcome to this month's edge talk.

The Edge talks are delivered by the NHS Horizon team. We are a small team whosupport large-scale change and build energy for change throughout the system. Youwill know some of the work we do for the School of Health and Care Radicals and inthe recent Hackathon. We have also delivered the Edge, which you can join throughthe internet.

Just to let you know, there are several ways you can contribute in this session. Youcan get involved in the chat, and that is on the bottom right hand side of your screen.Just type in and be part of the discussion.

You can also get involved via Twitter, using the #EdgeTalks.

We'll be feeding back throughout the session on what is happening in the chat and onTwitter. You can also get involved in the discussion after the session, and that can bethrough the School for Health and Care Radicals' and the NHS Edge Facebookgroups. For the School of Health and Care Radicals, you must send a request to join.

As you can see, there has been a slight change of plan. The teams had to be resilientto change. Unfortunately, Jodie, one of our presenters has been unable to join us. SoPip has taken up the reins today.

Our presenters today are Rosanna Hunt, Pip Hardy, myself chairing the session andHannah will be our Twitter monitor today.

How resilient are you feeling today? As we did in the School of Health and CareRadicals, we have an icebreaker. We thought we would see how you are feeling today.We have images where you can see how you are feeling. Are you ready to hide away?Are you feeling overwhelmed? Are you coming out? Are you able to grow despite howrough the territory is? Or are you ready to run this race? Are you on top of the world?How are you feeling today?

If you look on the left-hand side of your screen, there is an arrow or pen, so you cantake either of those and Paul should have released your pencil, so you can make amark when you are feeling today.

Most people seem ready to run and take on the world. That is fantastic. I think I will putmyself… This is where I am. I am feeling on top of the world. I am ready for actiontoday. Really excited about this session.

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I love the icebreakers. It is great to see how different people are feeling. OK, Paul, ifyou want to take the pens off and then we will move onto the next slide.

What I will do now is hand it over to Rosanna. I just have to go down the list.

Thank you. Thank you, Rosanna. I believe you have presenters right now.

ROSANNA HUNT: Thank you. It is really nice to be here and talking about resilience. I work in the Horizonteam as a research associate. My work has been building new approaches. I have abackground in psychology and 11 years in the NHS, so I have some experience ofdeveloping my own resilience.

This morning, what we would like to cover is some definitions of resilience, and alsolooking in some more detail at the biology of resilience. What is happening in the brainwhen fear is ignited.

We will keep this very practical as a session. There is some theory and evidence, butmostly it is very practical. We have uncovered some approaches for developingindividual resilience. For example, I will be handing over to Pip to talk about how youcan develop individual resilience, but also to Ashok who is joining us from India andhas expertise in using mindfulness and meditation for developing resilience, and lots ofresearch to share this morning.

We will end the session with practical approaches for developing team resilience.

I see there's a number of attendees today from the School for Health and CareRadicals, and you might remember Helen's session, where she touched on resilienceand mentioned the importance of connectedness for one's own resilience.

Developing our resilience as a group is something that can really help to build ourenergy together. Do keep contributing to the web chat. Carol will keep an eye on thatand we will get some summaries on what you are talking about throughout thesession. Have a go if you have not already.

I picked up this definition of resilience. It will be interesting to see what words actuallyjump out at you from the page. What do you resonate with from this description? Thisis from Robertson Cooper and it highlights two elements of resilience. Being able toachieve successful performance, and achieve positive well-being when there wasadverse conditions. But also when there is misfortune, change, or unexpected events,to be able to respond to that and to adjust.

It is very much about being flexible. So, positive well-being has been picked out bysomebody already. Just put a note in the chat box to say which of those phrases really



sticks out for you.

I think one of the… "Recover," says Francesca.

I think I will go onto resilience and reframing. There is a lot of mounting evidence nowthat shows some nations are actually populated with happier and more resilientpeople. One nation in particular is Denmark.

Studies have shown that the Danish have a particular approach to raising theirchildren, which leads to more resilient adults. The key is teaching them to reframeevents, which at first might seem frightening. Take the encounter with the spider, forexample. Or with a dog. Do you go "Eek!" and protect the child for their imminentsurvival, or do you help the child reframe the event and investigate the spider?

Eeyore is one of those characters who is constantly depressed, but is resilient at thesame time. He is able to reframe events and look for the positive.

Part of resilience is reframing and managing that tendency to leak into fight or flightmode, when really, often the threat isn't actually to our survival. It is really just a primalreaction in our brains that causes us to react in a fearful way. We will look at how thataffects the brain in a moment.

I think a common misconception about defining resilience is that it is about this RockyBalboa definition of resilience. It is about being able to be hit and keep standing, beingtough and immovable. It is not about being tough or immovable, it is about beingflexible.

Particularly when we have to react to change, it is about what Robertson Coopercalled bouncebackability. How quickly can you bounce back from a negative event? Imight go further and say it is about how you deal with that change in the moment, andjust notice your reactions to that event.

We do have this tendency as humans to catch fear from each other, or we feel, forexample, compelled to act quickly in a flight or fight situation. For example, that emailyou wrote that maybe should have been left overnight before reviewing and sending it.

Resilience is about being able to adapt to change. I think many of us are actuallyoperating in an environment of perpetual change at the moment, and uncertainty.

I do not know if we have got the poll available? If it is available, it would be good tohear. Or just write in the web chat some responses to that! How many of you areoperating in an environment of perpetual change and uncertainty in work at themoment?



I think certainly there are certain aspects of resilience that are particularly important forus to pay attention to, such as having a personal sense of purpose. Those are thethings that can help us to adapt to change.

Revisit those things and remind ourselves of what it is we are wanting to do. The poll isavailable. I can start it. Polling notice!

So, to what extent do you operate in a state of change and perpetual uncertainty atwork? Your options are all the time, most of the time, sometimes, or never.

You have a minute in which to respond and we are starting to get some answersalready, which is fantastic. I have never done this before.

We have 50%, all of the time, 40% most of the time, some are in the lucky environmentof sometimes being in an environment of perpetual change, and absolutely nobody isnever in that situation. That is very reflective of the times in which we live.

Let's have a look at the impact of change on the brain. I find this interesting. This isscientific evidence of where the energy comes from in our brain when we arepresented with an unexpected event or change.

There we go. When we do something fairly mundane, the activity is happening in thebasal ganglia. We take in new information, and we carry on with the example of drivinga car. When something comes into the road that is unexpected, we take in that newinformation, match it against the old, and that happens in the prefrontal cortex, which iswhere we are doing a lot of our thinking.

The prefrontal cortex is the whole front area of our brain. It is the most evolved area ofour brain. It is the rational thinking area. If something unexpected comes in then theorbitofrontal cortex comes in. Thinking moves away from the rational areas to theprimal areas of the brain. And if there is a reason to be fearful, the amygdala isactivated. This area enables us to react quickly and emotionally to new andunexpected information that poses a threat to us and drains all the energy from theprefrontal cortex.

When you are in a fear zone, it is not possible to think rationally, and the emotions areassociated with fight or flight. We will not respond to this, we will just think emotionally.So when we are confronted with a threat to our survival, we find it harder to thinkrationally. We have to activate some individual strategies for developing our resilienceand moving the energy back into the rational thought area.

Let's share our strategies for getting into the rational thought zone. Use the web chatto share your strategies.



While you are having a think about that, I will share a little recent story – it was about afew years ago now. I was confronted absolutely with the awareness that I was goingout of the rational thought zone and into the fear zone and had to have a strategy forthinking rationally.

I was threatened with redundancy and put at risk for several months, but then one daya letter arrived and said, "Actually, no, you are not going to be made redundant, youare going to have another year of funding."

I immediately thought of all the threats to my survival and couldn't think rationally abouthow I was going to handle that year. I realised quite quickly that this reaction wasactually going to affect my own health, and it was not going to be helpful to my future.

I decided to sit down to work out my short-term goals and come back to my purpose –what does this new environment sent to me in terms of opportunity?

Literally within weeks, I found a secondment opportunity that enabled me to achievethe purpose that I felt was right for me at that time.

Wonderful comments coming through about reframing in the moment and sharing withtrusted friends, building social energy, I suppose.

Thank you, everyone, for sharing. I'm going to hand over now to Pip.

PIP HARDY: Thanks, Rosanna.

It is really nice to be here this morning.

I thought I would start off – I know that Rosanna has already spoken about how we livein a world of change, but I was thinking that it is not really just a feature of our times.Change is pretty much constant.

The Greek philosophers talked about everything being influx and the Buddha spokeabout needing to reduce suffering by accepting change.

As Ben Franklin said, there are a couple of things that are definite. One is death andthe other is taxes. Set in the context of those things, we can think about change.

This is a lovely picture. Carol, you might appreciate this. I noticed your comment aboutphoto walks. It reminded me of how the leaves fall from the trees in order for the treesto rest and regenerate in order for there to be blossom in the spring and perhaps fruitin the summer.



We need change. It can sometimes be scary and unpredictable and uncertain, butactually it is just there, all around us. Sometimes it can be really helpful to think aboutthe positive aspects of change.

I work a lot with stories, as some of you may know, and I think this is a lovely quotefrom Tolstoy. He talks about the great literature that we all love is only one of twostories – either somebody goes on a journey or a stranger comes to town. Myinterpretation of that is that either we go in search of change, so we take a vacationalways start a new job or move to a new town or we begin a new relationship, or astranger comes to town.

It may be a welcome change. The person could be the love of our life. Or it may beless welcome, it could be illness, redundancy, or any of the other challenges we face.

I think those are some of the things we are talking about, certainly in the School forHealth and Care Radicals.

There is something about trying to balance the good changes with the changes thatare often imposed upon us.

This is quite a famous model of change and transition, and I think it is quite a usefulone to help us understand how we actually deal with change. If something is changing,we are in one situation, and at some point that one situation or state of mind or state ofbeing is going to finish and we are going to have to make an ending and let go of thepast situation.

I find it quite helpful to think of this like a river that you have to cross, and only whenwe have actually gone through the feelings, which may be feelings of shock or angeror despair, denial or disbelief that a change is happening, and it may take time tobecome accustomed to the new state of affairs, to the new job, to the new baby, to thenew house, to the new town.

But at some point we do actually cross over this neutral zone and we find ourselvesable actually to make a new beginning.

There are various ways we can do this. I don't know, many of you may be familiar withcognitive behavioural therapy, which is a common way of helping people addressissues they may face in terms of if people are feeling anxious or depressed orconcerned.

I had the good fortune to have some CBT a few years ago when I had had a reallychallenging couple of years both personally and professionally, and this was one of thethings I found most useful. It is the A&E activities monitoring sheet.



I'm sorry this is so small. When I put it into PowerPoint, it insisted on doing this tinything. Hopefully you can see across the top the days of the week, and next to each daya small A and a small E, and down the side, the vertical axis, there is just morning,afternoon and evening.

The idea is that for a week you monitor your activity. In the morning, for example, youmight get up and have a cup of tea and a shower and then you may drive to work. Youcan rank those things on a scale of one to 10 in terms of their enjoyment or your senseof achievement.

Generally, having a shower and brushing your teeth, you may have a great sense ofachievement or accomplishment, but they may not be particularly enjoyable. Later inthe day you may be able to go for a walk and that could be a lovely thing to do in termsof enjoyment but maybe not high on achievement.

By the end of the week you can notice how many things you do that you enjoy andhow many things you do that you have a sense of achievement. When I was doing thisin my first week I took it back to the CBT therapist and he said, "You don't seem to bespending much time doing things you enjoy. Next week, come back with many morehigh scores in the enjoyment ranking."

Just having somebody say that made a great difference. The result was that I alsoended up feeling a greater sense of accomplishment or achievement by doing things Ienjoyed, and gradually I felt better.

It seemed like a really practical thing that people might enjoy spending some timedoing at the end of each day.

Another one of the things you can do to actually build resilience is to develop orcultivate a sense of gratitude or appreciation.

If I can stop myself and change my mindset to something that I feel grateful for, it couldbe a beautiful spring morning or an unexpected daffodil… This is my littlegranddaughter, who was staying with us last weekend. It is very easy to feel a senseof gratitude for the little people in our lives.

I have often found that a really helpful way to develop resilience.

This is another thing Kate and I were talking about last night. She said she alwaysfinds it useful to have a 'heart sing' project on the go. I like gardening so that is aproject that always makes my heart sing.

Another project I have enjoyed being part of over the past three years is the School forHealth and Care Radicals.



In among all of the other things you do at home and work, try to find a project that willreally did you joy and a sense of accomplishment.

This is something that was said to me by a Vietnamese acupuncturist. She said to me,"You need to think of your work and think of how you do your work, and think aboutyour heart as a muscle that needs to contract but also needs to relax. If it doesn't relax,it can't continue to do its work." She said, "between every patient I take 5 minutes towalk around the garden, and that allows me to relax before the next patient."

Even if it is just a few moments, give yourself, your mind and body an opportunity torelax a little bit so it can do the next bout of work more effectively.

We had a storytelling workshop here this week, and one of the participants told a storyabout the challenges that she faces as a change agent and how she often ends up justtaking everything on and then becoming exhausted and burnt out and realising shecan't do it all herself.

It can be a really helpful thing to ask for help, to muster your resources, get yournetworks, surround yourself with the people who can help you to accomplish your task.

This is a picture of a barnraising in America. If you try to build a barn by yourself, it willtake weeks, months, possibly years, but if you gather the community around you, youcan often do it in days.

An American colleague of mine says that "every day, I only have three or four thingson my to do list, and one of those things is to eat lunch." That's another really goodprinciple to follow when you are trying to build your own resilience. Make sure you takea break, have some lunch, and try to limit the number of things on your to-do list.

It would be lovely, I think, at this point, if you could take a bit of time and put some ofyour thoughts in the chat box about what you do to build resilience and share some ofyour own experiences with us, with the rest of us.

Put a few things in the chat box about what you actually do to build your ownresilience.

I'm sure some of you must be doing something to be resilient.

Small to do lists – yes, a good thing.

Focusing on how lucky we are – that's a lovely way of expressing gratitude.



Breaking big things down to little ones.

Taking breaks.

Going for walks – I'm with you, Tony, on that one, definitely.

Doing things like tai chi. That is a great opportunity for relaxing and developing yourstrength and your flexibility and your balance.

OK, so, people are obviously finding physical activity and doing exercise of differentsorts… Those are really helpful suggestions.

Just a final slide from me. Do keep on putting your ideas in the chat box, please.

I have to briefly talk to you about the last slide, which is about your five-a-day buildingresilience. First of all, making connections. Connecting with people who are yourfriends, loved ones, your family.

You are active. A lot of you have talked about the need to be active, go for a walk, dodancing, take exercise, do circuit training, run 10K. Whatever it is you do to getyourself out of your chair and doing something outside.

Take notice of small things. Be curious and investigate the little things. Look at flowersand start to smell the roses. Try and be curious about your friends and colleagues, andwhat they are doing. Notice how things change. Try to pay attention to each momentand savour the moment before each one comes.

Then the next one of your five a day is try to keep learning. It can be incredibly helpfulin terms of building your resilience to take a course, do something different, pushyourself outside your comfort zone. Learn to do ballroom dancing or computerprogramming or coding or a new kind of cooking. Maybe you want to learn to do Thaicooking or learning to cook at all. Anything at all that will keep your mind active andengaged in a new opportunity to do things and look at it differently.

Finally, the last of the five a days is to practice giving and generosity. It may be givingof your time, your money, or your skills. But try to find somebody who will benefit fromsomething you have to offer. You will discover or rediscover how lovely it can be to begenerous with your time and talents.

That is all from me. Thank you for listening and for your comments in the chat box. Iam now going to pass the presenter's rights over to Ashok.

ASHOK GUPTA: Hello, everybody. You can all hear me clearly now? Thank you so much to Kate,



Rosanna and Jodie and Pip for inviting me to talk about resilience. I have enjoyed thepresentation so far. It has been fascinating. It is great to be with you all.

I am here in India at a large gathering of people meditating together. I am about to goto a big airfield with 3.5 million people meditating, so it will be great. It has been areally eclectic day today.

I run a clinic specialising in treating stress illnesses. ME, fibromyalgia and anxiety. Imyself suffered from ME and chronic fatigue syndrome when I was at university. I gotmyself into quite a mess. I had to degrade one year at university. It was a very difficulttime.

I went on a journey of trying to understand what this was about. I am sure some of youas practitioners in the NHS will have come across patients who suffer from thedisorder. It is very difficult to treat. I did a lot of research myself into the brainology ofthe illnesss, and I got myself well. I opened up a clinic to help others with the condition.I published a couple of papers on the brain neurology of chronic fatigue syndrome.

In 2007, we published a home study course, so now we have patients all over theworld who have DVDs and videos on how to get better from the condition. We alsohave webinars. We have practitioners all over the world to treat the patients.

We have had a couple of small research studies which have had positive effects onthe tools I am about to talk about. That has been very positive. We are looking to raise$200,000 for a large-scale clinical trial either within the NHS or outside. We are lookingfor partners.

That is the background to myself. I will now talk about some of the research aroundmental health problems people currently face which reduces their resilience, and sometools and techniques that can practically help us develop that resilience. It is like Rosanna said - what are the issues in the mind and brain and how do wefocus the tools and techniques to target those particular issues? I will share with you acouple of interesting studies.

The first one was by the BBC in association with the University of Liverpool. One of thelargest studies on anxiety and depression, which is the two most common mental-health conditions people experience. In fact, the World Health Organisation estimatesthat by 2020, depression will be the biggest illness in the world that people face. Thatis shocking.

This study looked at 42,000 participants, looking at the life events, experiences, etc.The study found that the biggest predictors of anxiety and depression or any kind ofmental conditions was to firstly dwell on negative thoughts, and secondly self-blame.



Which is really fascinating. Whatever we have been through in life, and the commonones were trauma, childhood abuse, bullying, etc, it was not the events orcircumstances in our lives, or even current circumstances which determined levels ofmental health. It was dwelling on negative thoughts and self-blame. This was such aninteresting and definitive study, because it was such a large number of participants. Itdid back previous research.

Essentially, we are saying the nature of the mind is by default to dwell on the negative.That is one of the aspects of our mind. A default setting of our mind. The mind keepsgoing into the past or the future. When the mind goes into the past, it dwells on thingswe're angry about, things we regret, things we're sad about.

When our minds dwells on negativity about the future, it tends to go into fear andanxiety about the future. Generally, our mind goes to negativities about the past or thefuture. That is the biggest predictor. If we can understand that and control that, thatwould be the holy grail of mental health.

The second aspect is self-blame. Self-blame is looking at actually how we putourselves down and we are negative on ourselves, and that can be a big predictor ofmental health issues. Low self-esteem, or what I like to term "low self-love", which canbe different.

Sorry, someone is just asking about 'understand and control'. Understand and controlthe dwelling on the negative thoughts that go into the past and the future.

That is an interesting start for us. The second study which I would like to share withyou was a study which I think should have made international headlines. I think, onceagain, it's a landmark study. This was a study that was missed in the journal Plus One.It was 5000 participants going through a stress resilience training course.

The first bullet point, and I don't normally like having lots of words on a slide, but thiswas fascinating to me. Stress-related illnesses, such as anxiety and depression, is thethird-highest causes of health expenditures in the US.

This shows us this is not small things we are talking about. This is large-scaleexpenditures in the health services.

The second point. "Over 90% of people suffering from stress seek help from primarycare, and these can comprise 70% of a physician's caseload. In 80% of patientspresenting to general practice they lack evidence of resiliency to psychological stress."

This is an incredible statistic. It shows that the vast number of illnesses that presentthemselves to the GP, the GP cannot do much about it. They can give treatments to



relieve pain or other aspects of the conditions, but most GPs realise that thoseemotions are the underlying consequences of stress, anxiety, and depression. Theycannot target them in a five-minute consultation.

The most important statistic: those 5000 participants had an average reduction of 43%in their use of healthcare services in the year after participation.

Imagine there was a pill that could reduce general healthcare use by 43%. It would bethe miracle cure of the century. And now we have the clinical evidence that supportsthat. We have this landmark study.

What were the two aspects of this resilience training? Number one was relaxation. Thesecond was resiliency training. I will skip forward a few slides here.

This shows us that the way we develop resiliency, I see it as the wings of a dove.There are many practitioners focusing on one or more of these. When we bring themtogether, they can work powerfully together.

One of the wings of the dove is what Pip was talking about. Developing cognitive skillsand positive psychology. Normally, we are engulfed with our mind and moving aroundwith our mind. It is controlling us. But if we can take a step back, we can consolidateour awareness within our prefrontal cortex and observe what is going on in ouremotional minds. We will be able to temporarily dissociate, observe what is going on,and refrain those experiences. We will shift perspective. The second aspect ofresiliency training is meditation and mindfulness. Stimulating the deeper relaxationresponse. If we have one of those things, certainly we can reduce our stress, but I donot think it is the whole story. When we combine together, it is incredibly powerful.

If a dove was using both wings, sure it would be able to fly, but it would not havedirection. The tail feathers represent purpose. Giving our lives purpose. Engaging ourminds with a positive activity of being of help and service to people around us.Expressing gratitude through a sense of purpose in life. That is also something we candevelop.

But in primary and secondary healthcare, those two wings of the dove, if we were todevelop themselves across ourselves as practitioners, but also to the widercommunity, what an impact we would make.

I will go back to this lead. A reduction of 43% in the use of healthcare services. Thisbacks up the positive results of meditation and mindfulness.

Looking at some of the positive clinical effects of meditation, we know that people whoregularly meditate have reduced stress, anxiety and depression. We will know that justas I showed you that analogy of that diagram Rosanna showed us, our prefrontal



cortex, when we regularly meditate, is better able to control the responses of theamygdala. The rational thinking brain becomes stronger and decreases activity in theamygdala. That is very exciting.

Secondly, we know there are physiological brain changes. Increasing grey mattervolume and other changes we can detect. Meditation is not just a nice thing to do. Wenow notice the exact effects it has on the brain. It changes gene expression andboosts the immune system. It reduces inflammation. We know a lot of modernconditions are being triggered by too much of an inflammatory response in the body.

And that last statistic - heart attacks, strokes and cancer are the biggest killers. Weknow people who regularly meditate have a 66% decrease in heart attacks andstrokes.

Meditation and mindfulness has a huge amount of research behind it. It was a joke, wewould see it as a miracle drug. But it is available to us for free and has very fewnegative effects, if any.

So we are mentioning that we love how plastic the brain is. This idea of neuroplasticity,we used to think the brain was very fixed. But we know that the cognitive processesand regular meditation, we can take advantage of this idea of neuroplasticity to rewireour brains.

I have been excited. If we can somehow distil all this knowledge and research into akind of pill, the aspects of a pill that it is easy to access, consume, and we know it hasthe clinical effects.

What I have developed is an app. This part of my business is a social enterprise. Thisis a not for profit app. It is called the Meaning of Life Experiment. Within this app, thereare 30 meditations and short mind exercises. A lot of 10-20 min meditations, as well as30 videos.

There are lots of engaging videos, and the idea is it is a 30-day experiment. Every dayyou take a 10-20 minute meditation. You watch a video and you answer some of thosequestions. It takes around half an hour each day.

"I can't do 10 minutes." Within the exercise, there are 3 minute meditations, 4 minutemeditations…

This is just my clinic giving back. We wanted to create an app that was easilyavailable, that was free, and could take all the different mind tools that we need for acalm and happy mind.

We thought we could create an app that was a nonbranded app that any organisation



could take and present to their employees.

Something I have been speaking to Rosanna and Jodie around is could we create abeta app for NHS staff? Could we put it out there and see what people's experiencesare? Could we create a study where you take 1000 nurses and doctors might testthem on various aspects of their lives and visiting healthcare, get them to use the appfor a few months, and then test them again to see what research evidence comes backto support the use of this app.

If we test this with actual NHS staff and they start noticing the benefits, they are morelikely to share that with patients. From then on, because we have the clinical researcharound meditation and mindfulness anyway, could we actually create an app that wecan give to patients? Could we, in the longer term, reduce NHS costs by bringingresiliency training to the mass population?

NHS costs, as we know, are skyrocketing. We as a society can't afford the healthcarecosts of the next 20 years, because of an older population as well as increases inlevels of stress and depression in the populations. Can we create a tool that canactually reduce healthcare costs?

Other aspects of resilience – sleep research is an important part of that, and within theapp we have different meditations that can help you to get back to sleep. We have gotpeople who have never been able to meditate because they think their mind is tooanxious. When they have used these, they have been able to get back to sleep.

I specialise in creating meditations for people with busy minds who thought they couldnever meditate. Obviously physical exercise is something that we know can help withresilience as well.

Somebody is mentioning staff sickness. Absolutely. We know that within socialservices, within the public sector, the levels of absence, of sickness are actually higherthan the private sector. The levels of stress are higher. That is why all of these tools…First and foremost, they could have a massive effect on current staff.

Certainly I would encourage you to download the app and have a play with it and giveme your feedback, because that would be really interesting for us as a starting pointbecause we're looking to take the app to the next age. We have got about 7000-8000people using it so far, but the current version is available.

Or there is a facility where it asks you how you are feeling. You might say you arefeeling happy or sad or stressed. Depending what you click on, it then presents youwith a short or long exercise you can do to help you with that particular mood.

For me, this is all about putting this out there. There is not a profit stream on this. That



is why, for the NHS, it would be interesting to take some of the content we have spentthe last couple of years developing and actually creating one that is NHS branded andsaying, "This is a beta test, let's see what people's responses are."

If you want to access this online, we have also got a website –www.themeaningoflife.tv.

The life purpose videos are there at the end of the experiment. If people are not feelinga sense of purpose, these videos really help them to reconnect with that.

Somebody mentioned the idea of 'dementis'. Resilience is our ability to cope withstresses, people and situations that present themselves. With people, it is all aboutdeveloping that sense of stillness and centredness and strength, to not allow theirnegative energy to affect us, and with situations, as people have said, it is the ability totake a step back from the situation and, for instance, to understand that it could be forour growth or some other kind of reframing around that.

Just to end my session, I thought it would be useful to give you a couple of takeaways.I could take you through a five-minute guided meditation, but I know that meditation issomething which now is very easily accessible to most people, and if you download theapp, there's tons and tons of meditations on there.

Rather than that, I thought I would take you through a tool I have developed. It is calledthe new groove technique. It is a very short technique that can help us reframe aparticular person or situation that we are going through in our lives right now that easilygets us into a positive state.

I thought I would give you a very practical tool to take away, and hopefully you willhave a chance to experience the guided meditations on the app.

First of all, I want you to think about a particular situation in your life right now that iscausing you a lot of stress. It might be that you feel unfulfilled in your career or it mightbe a particular difficult person you are working with right now or a difficult personalproblem that you are experiencing.

The new groove technique – each aspect of the four stages we will go through beginswith S. They are 'stop', 'surrender', 'shift perspective' and 'substitute'.

If you like, we can do this with our eyes closed.

If we just close our eyes and let's take a slow, deep breath in.

Then breathe out.



Once again, I would like you to think about that particular situation, that negativesituation that you are finding difficult in your life right now, whether it is something smalland local like a difficult personal situation or a person you are finding it difficult to getalong with, or whether it is a difficult problem in the longer term. But something that iscausing you stress or anxiety or sadness right now.

The first step of the new groove technique is first of all, in your mind, to take thatmoment to just stop and take a slow, deep breath in. If we just do that, if we justimagine the word "stop" in our mind, take a deep breath in… With a smile…

And as we breathe out, the second letter S is "surrender". Breathe out and imagineyou are surrendering and letting go, which means bringing your mind to the presentmoment and releasing the stress and surrendering it.

Some people find it easier to surrender to somebody they see as love. It is letting go tosomething that represents love and gratitude.

Keeping our eyes closed, we will repeat that process. Imagine, after this webinar,something is really stressing you out. You just imagine interrupting that flow of thoughtby saying, "stop" in our mind, take a deep breath in with a smile, a big breath in, hold it,and then we breathe out with a smile and just imagine surrendering it to a sense oflove and gratitude.

Keeping our eyes closed, the third S is "shift perspective". Looking at this personalsituation or problem we are facing, how could we change that problem into a challengeinstead? How can we shift perspective to look at this situation differently, from apositive perspective? What is the positive in this situation? What is something positivethat could come out of this situation? How could we reframe it in a positive way?

Just spend a few seconds thinking about how you can shift perspective on thisexperience.

We can be really creative in how we think about shifting our perspective and looking atit differently.

Once we have now got that new perspective, if you haven't got a new perspective, oneof the global perspectives we can take is that every challenge that comes to us can beseen as helping us to grow in some way.

Nobody ever became more resilient by having a happy, easy life. We developresiliency and grow when we meet those challenges because it forces us to becomemore resilient.

How could this challenge actually help us to grow in some way? Where is the growth in



that situation? That is the global shift.

Finally, the fourth S is "substitute". Thinking about a person, situation or challenge.Armed with this new perspective you have got now, how do you choose to feel inrelation to this personal situation?

You might have some personal affirmations, such as "I feel calm and relaxed in thepresence of this situation. I choose to feel calm around this situation. I choose to havea new perspective and a positive attitude to this situation."

Now, we will install that into our bodies and really imagine what that feels like. Imagineyou have fully taken on this new perspective and new way of thinking about thesituation. Take a slow, deep breath in.

And with a smile, as you breathe out, relax your whole body. Keeping that gentle smileon your face, imagine holding on to how you choose to feel in that situation. How doesyour body feel, how does your mind feel?

Say in your mind those affirmations, such as "I feel relaxed in this situation. I know Ican handle this situation now. I choose to look at the opportunities for growth."

In your mind, say those affirmations. Remember the smile.

OK, great. Keeping our eyes closed, we will repeat those four steps of the new groovetechnique, all beginning with S.

We might think of the same problem again. Imagine you are having those lost,negative thoughts about that problem, situation or person. A lot of negative thoughtsrunning around. In our minds, we say "stop". Take a deep breath in.

With a smile, just surrender and let go of all those worries and cares to arepresentation of love and gratitude.

Now with the third S, reflect on how you can think about this situation differently.

And the fourth S, take a deep breath in. As you breathe out, physically and matchingyour whole body and mind has taken on this new perspective and, out loud or in yourmind, you can say some sentences and affirmations that summarise how you want tofeel in relation to this personal situation. Really imagine feeling like that. With, "I am", "Ifeel" statements.

Good. So, let's take a slow, deep breath in. And let go.

And when you are ready, you can just gently open your eyes.



OK. Great. Just to finish off, I hope you will get an opportunity to have a play aroundwith some of the videos and meditations within the app. I am very excited to speak toanyone who would be interested in white-labelling it, creating it for a particular group ofpeople or NHS staff, and offering these tools to the masses. This would not haveworked 20 or 30 years ago. It would have been seen as far too alternative and strange.But the time right now is ripe. Ideas around meditation have become mainstream.People are open to it. These tools and techniques can create a change in the way wedeliver care and shift emphasis to preventive health care.

People on the planet will produce more resiliency, reduce their stress, and reduce theirspiralling healthcare costs. It has been exciting to share this information with you.

Unfortunately, I have to leave very shortly. But if there were any questions people havearound resiliency or meditation or anything else I have shared... Kate, I don't know if Ihave time to answer questions or if you need to move on?

KATE POUND: Thank you, I think we will take the questions if you have to go. If you can pass theglobe over to me, we can certainly keep a record of any questions if you have alreadyleft the room by then. Thank you, Ashok, for that.

I was reminded of that phrase, "Change starts with me." I wonder how many peoplewere able to work through that new groove technique without having a quick, sneakylook at the emails coming in.

We work in an environment that is very much about multitasking. It is the completeantithesis for us. And I think that, across the organisation, to stop and do one thing issomething we do not necessarily have practice at.

It strikes me that so many organisations are investing in this. Warwick University nowruns guided meditation for staff and students. Dame Carol Black did a review of healthat work in 2008, and found that being invested in employee health and well-being is onthe rise. We are more productive when we are in good health. The Department ofHealth has shown that productivity is 20% higher when that is the case. Organisationsare beginning to see, and have been for some years, that it is worth this kind ofinvestment.

I would absolutely love if, as John said, just imagine this happening at every trust. Youhave already said, Ash, staff sickness is high in the NHS. It would be a great place tostart with NHS staff.

I will move onto practical approaches for developing team resilience. I will refuse toapproaches. But I am sure those of you who are working with the app team has



employed various approaches. I would love you to be able to share those.

We need our resilience to change the world. If we can build resilience together, we willachieve greater connectivity than before. Plus, it makes it more socially acceptable, Ithink, to focus on resilience and take this as a priority in our lives. Not just somethingwe do when we finish work, or the alarm clock goes off in the morning. We do somemeditation before we goes to work.

Let's look at a couple of approaches. The energy for change approach is a way tomeasure a team's energy when a new event or change comes our way.

I have put some instructions here just to keep this very practical, in terms of how youwould access this as a group. So, the five images that are measured arepsychological, spiritual, social, intellectual and physical. Those of you who are in theSchool will have had some exposure to this through the School for Health and CareRadicals in February.

The central energy is about resilience. When psychological energy is low, we are inthat sphere. We think that change poses a threat to us. But when psychological energyis high, we're feeling safe in the environment.

In terms of spiritual energy, we need to make sure that we have a sense of purpose,and what Ash has suggested is we look back at our life purpose and so on. But this isalso about developing that in a team way. Looking at how you can develop spiritualenergy and how you can develop your sense of shared purpose. Maybe that is aboutbeing honest about your purpose, and adjusting the change and integrating changeinto our shared purpose.

'Social energy' is very much about doing this as a group and building a sense ofconnectivity and solidarity. 'Intellectual' is developing what is the reason for doing thischange?

'Physical energy' is about putting the energy behind it, but also managing physicalenergy and making sure we are taking those lunch breaks that are needed and we arealso taking the time to do physical exercise and to look after our nutrition.

I think people have made comments about physical exercise and nutrition as a way ofmaintaining resilience as well.

A team can measure their energy as a group. Use a questionnaire that is availableonline.

Just as becoming aware of physical energy, you can start to address those things. Asa group, if our energy is low because we have social energy, then we can put some



things in place to build up our sense of solidarity. And also psychological energy, youmight look at doing some team exercises around strength, for example. I will go on tothat in a moment.

With the energy index, you can pick it up and it is free, as Ashok's app is free.

The second tool I would suggest is the Strength Finder from the Gallup organisation.They say 33% of people are engaged at work. I'm sure you are all hearing similarkinds of statistics. There is some evidence from the Gallup organisation that if we lookat, as a team, at developing and understanding what strengths we bring to the team,then we can build our resilience to the future and to changes.

These strengths finder measures individual strengths on individual categories. I willpick up a few to describe to you. A few are particularly pertinent to us.

One is the achiever, which is people who are exceptionally talented in the achievertheme work hard and produce a great deal of stamina. They take immense satisfactionin being busy and productive.

I think quite a few of us are also connecting with the connectedness definition, sincewe are working together on the School for Health and Care Radicals and taking part inwebinars together to extend our learning.

People who are exceptionally talented in the connectedness theme has faith in the linkbetween all things. They believe there are few coincidences and almost every eventhas meaning.

That is a couple of examples. There is one which does not show up on here, which ison the bottom, which is the 'Woo' one. I wanted to describe it because Kate isparticularly interested.

Woo stands for something. It is about loving the challenge of meeting new people andwinning them over. We derive satisfaction from breaking the ice and making aconnection with someone.

These are all strengths that individuals hold that they can bring to work, but you maynot even necessarily be getting an opportunity to exercise this strength. So, usingthese measures and engaging in some team exercise where you share what yourstrengths are, you can look at how you can build up your strength. The opportunity touse your strengths at work, as I am sure is obvious, if we are going to build up ourstrength and resilience together at work and build up our energy and passion for thework, we have got to be able to be in a position where we are using our strengths andgetting some kind of recognition from others as well, that our strengths areappreciated.



So, I note we are nearing the end of our webinar this morning. We will go over to Carolin a moment to summarise some of the web chat and let us know what has been goingon on Twitter over the last hour or so. But before that, it would be good to hear fromparticipants about whether you have any team initiatives you have undertaken to buildresilience together.

If you could use the web chat again to share that.

The Strength Finder is from the Gallup organisation. You can find the questionnaireonline. I think it costs 10 American dollars or Australian dollars.

I think it is called the comfy chair exercise. Members of the team will take turns beingin the chair.

Then talk about in what situations at work you get to use your strength and where youmight get more experience.

Then you go to the other group members and they say what specific occasions theyhave seen you use your strength in the workplace. You can also go around and say,"What cheeses this person off?"

Then you get to say, "Are you right? Are those the things that annoy me?" And you cantake turns being in the comfy chair.

You can also do a little bit of brainstorming as a team. Sometimes environments arenot conducive to our strengths, but what can people do to create a work environmentthat enables them to use your strength?

That really is very powerful way of creating a vibrant and resilient group, and alsohelps to get to know each other better, because we are confined in our professionalroles and yet we have so much more to bring to the workplace.

Thank you for contributing some suggestions here for building resilience.

We have got some coffee and cake suggestions and recognising achievements withinthe team. I totally recognise that one, Rosanna. We had a team development sessionwhere we had a book – I still have mine on my bookshelf, and it is lovely. Everybodywrote three things they appreciated about me. That helped to build personal resilienceand it is a great exercise to see why you appreciate your teammates.

"Recognising achievements within the team helps build resilience." Absolutely.

Lots of focus here on using achievements and remembering everyone in the team a



little and often.

We are all on John's team because he is a freelancer! Thank you for including us onyour team.

Before we close, and I will hand back to Kate in a moment, could we hear from Carol,a summary of what has been happening on the web chat and Twitter?

Oh, look, lots more comments coming through. I hope you are reading, Carol!

I think we are having some trouble getting Carol off mute. Just reading through someof these, improvising is a good team game and a skill that is not always valued.

HANNAH: Can you hear me? I could just read out a couple of comments that have come throughon Twitter.

It has been quite quiet this morning. We have had a small but perfectly formed groupwho have been listening intently to what everybody has been saying and contributingin the chat box. We have had some comments on Twitter, really positive comments.

"Loving the stuff you said in the case study."

Michael Goody, a dear friend of Horizons, he said at the beginning that he is needingsome help at the moment, so this is obviously very timely for a lot of people.

Louise says a personal thanks to Pip, saying she enjoyed the presentation.

Patricia says that dwelling on negative thoughts are the most common mental healthproblems.

I think there are some really thoughtful reflections going on from everything that hasbeen said this morning and some useful tools and techniques that people have beenconsidering for use going forwards. So, yeah, all good, Rosanna. Thank you.

ROSANNA HUNT: I will hand over to Kate now.

KATE POUND: Thank you. It has been a really enjoyable session. We have learnt much more aboutthe understanding of the physiology of resilience and what goes on, and we have alsolearnt new skills, which I certainly will be looking at more.

I have been looking at the app. I am sure there will be lots of us downloading it later.



I just reflected a bit on the session today and how it links into all of the learning that welearned in school.

We learned that change starts with me. That is the first, taking care of ourselves,looking after ourselves, but then also moving further and taking care of our team andlearning how to build team resilience.

But really maybe think about the fact that we can't be rebels alone and we need towork together to develop resilience as a team to support each other, but then to leadon change together.

As we lead on change together, we become stronger as a team and then develop ourpersonal resilience.

So, thank you, all, for todays's session and we have all enjoyed having you here today,and that is the end of the session today.



Transcript from Edge Talk on Resilience

Healthcare

Transcript of Transcript from Edge Talk on Resilience