Resilience Series: Carrying Each Other

This is a piece written by Assistant Director, Drew Walker, to educate volunteers about the health impact of resilience, social support, and how these social psychological processes are embedded within daily life and within our actions as Streetlight volunteers.

Carrying Each Other

In our previous Resilience focuses, we’ve learned about some key psychosocial concepts that I hope will give you a deeper understanding of your own life.

I wanted to use this last focus in our resilience series to try to shed some light on social support—which is why we all came to Streetlight in the first place. I wanted to share some evidence as to why it is so important, how it’s related to resilience, and how to use these concepts here in Streetlight.

This is about the richness we get to experience in Carrying Each Other.

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Why Social Support is so Important

We all realize that us humans are social animals. Functionally, we rely on others and on contributions from others for nearly every aspect of life. Aside from the tangible benefits of sharing resources, we also need others for love, compassion, and belonging.

When we lack social support, we experience social isolation. Living an isolated life is more difficult, and more stressful. A socially isolated life results in a chronic activation of the stress-response cycle, which causes profound detrimental health effects in humans and animals .1

Even if you’re surrounded by people, sometimes it’s easy to feel isolated. Loneliness is defined in social psychology as “a perceived imbalance between one’s social needs and   quality of one’s social relationships.”2

Though it may not sound like such a big deal, loneliness is a powerful predictor of all-cause mortality,3 with individuals reporting high levels of loneliness at nearly 26% greater risk of death.4 Loneliness has also been strongly linked to increased risk for early-onset cardiovascular disease, where one study suggests lonely individual are 1.5 times more likely to have a first heart attack. Loneliness is commonly reported by adolescents and young adults experiencing frequent social interruptions as a result of lengthy and numerous hospitalizations, which is a common occurrence for patients living with cystic fibrosis,5 cancer,6 sickle cell,7 or for patients awaiting organ transplantation.8

This issue has actually become so widespread in many developed nations, that in the UK they have set up an official Ministry of Loneliness– which sounds like it would be the most depressing department at Hogwarts—which has actually made profound impacts in connecting citizens with their neighborhoods, and in highlighting the isolating factors of modern society.9

Hope in Social Support

The transformational impact of social support cannot be understated, and neither can the work you all come here to do each week.

So how does this happen?

One of the most often cited frameworks in this research area is the stress-buffering model of social support, which “asserts that social support functions as a buffer to mitigate the pathogenic effects of stress on individual well-being.”10

In a way, we can look at this as similar to the “Zone of Resilience” model from our first resilience focus (link coming soon!).

This framework has helped develop research that has shown that social support positively affects our hypothalamic-pituitary-adrenocortical system, (which controls reactions to stress, digestion, immune system, mood and emotions, sexual drives, energy storage and expenditure), as well as affecting our noradrenergic system (Stress response) , and central oxytocin pathways  (social bonding, love, trust).10

Many epidemiological studies are now supporting that the effect of social support on life expectancy is nearly as powerful as the effects of obesity, cigarette smoking, hypertension, or level of physical activity.10

For adolescent and young adult populations, it’s even more important that social support comes from peers and friends as opposed to other sources of support to support resilience and buffer stress.11

Through the various ways we relate to and carry each other socially, we actually help to build our physical resilience and mitigate the body’s adverse responses to life’s stressors.

How to use this in Streetlight

As Streetlight volunteers, we know the different shapes and forms a volunteer shift can take.

One shift, you’re just running around getting DVDs. On another, you’re holding a dance-off in lounge. Next week, you’re just holding someone’s hand, trying to think of the right words. In the next room, you’re swapping middle school horror stories. Next week, everyone is sleeping! You’re just striking out, and it feels like you’re just bouncing from room to room. Next week, you’re saying goodbye to a dear friend.

As we go through and explain some important social support concepts, I want you to think about the ways that you’ve experienced them through your interactions with our patients. In mapping our own experiences to these concepts, my hope is that it will provide insight into the value of your visits and help you recognize meaningful supportive opportunities whenever they arise.

Social Support can be grouped categorically based on the type of support that is provided.12

  • Emotional Support
    • These are expressions of empathy, love, trust, and caring.
      • This is when you provide hope and a listening ear to patients. It’s being there for them, showing they are cared for and have people they can talk to. “We got your back.”
  • Instrumental or Functional Support
    • Tangible aid and service
      • Helping someone out. It’s going to get DVDs, Video Games, Laptops, you name it. It’s hooking someone up with a BJ’s meal. It’s helping someone get on the Wifi. It’s getting someone’s nurse, or helping someone communicate.
  • Informational Support
    • Advice, suggestions, and information
      • We know we can’t give medical advice, but we can help with stuff like, school, friend/relationship drama, what shows to watch, careers, video game tips and tricks, and all sorts of other important stuff.
  • Appraisal Support
    • Information that is useful for self-evaluation and building of self-esteem
      • A patient says, “I’m just so worthless.” So, you sit down and talk with them about why they’re feeling that way, and help encourage them to take a more compassionate and accurate assessment of their situation. “Besides,” you might say. “Think of all you’ve overcome in the past.”

So how do we access patients in a way that will let us to provide this support?

We all know it doesn’t just happen as soon as you walk into a room for the first time. What’s interesting though, is that almost every component of the way we visit patients in Streetlight and develop friendships and bonds can be mapped onto the framework of a set of relevant social psychological concepts. 13

  • Proximity—the idea that you have to be geographically close to someone to meet them and become friends, or that you need the ability to contact them in some way. This is what patients lose in the relationships they already have when they come to the hospital. It’s what you act to restore anytime you walk into a room.
  • Familiarity—the idea that people are more likely to connect with others who are familiar to them. Through the Mere Exposure Effect, we prefer things we are used to. How do we do this in Streetlight? Anytime we see someone more than once.
    • Each time we see someone again, we can become a more meaningful and comfortable presence in their life. The first time you meet someone, they may barely acknowledge you. The second time, suddenly the say “Oh, hey man.” That’s powerful!
  • Similarity—the idea that people are more likely to connect with others who are similar. That’s why we read about patients in briefing. There’s comfort in similarities, no matter how deep or superficial. That’s why any information we can talk about in briefing has the power to help us connect. A note about this: I’m not advocating for only seeing patients who are similar to you. You will learn more in this program by meeting those who are different. Also, think about how powerful intros (or volunteers introducing Streetlight patients to the program) become. That initial chart entry has the power to grow many supporting relationships.
  • Disclosure—the idea that people are more likely to feel connected with others when there is a sharing, or “disclosing” of information. Every little bit of disclosure, no matter how deep or superficial, is a step towards building a friendship. When you listen, empathize, and validate what people are saying, they’ll be more likely to open up to you.
  • Reciprocity—the idea that people are more likely to feel connected to their friendships when there is a mutually ongoing exchange of support, disclosure, or interactions. It can be as simple as someone returning your “Hi” with a “hi” back. It can be as little as making eye contact. It can be as big as listening to a patient tell you about their cancer experience and you telling them about your own. We want to be mindful that we ultimately keep the focus on our patients, but this facet of relationship formation is powerful, and deeply connects with our mantra of “Carrying Each Other.”

As you give, receive, and participate in exchanging social support, your Resilience, and your little “Resilience Zone” broadens. Even if you get turned away all shift, you still showed up here for 3 hours and practiced altruism and bravery. Maybe those patients who weren’t feeling up to a visit still noticed that someone cared enough to stop by. That’s called Perceived Support,14 which is the way someone views the support they receive. We are assessing this through our Streetlight Patient Outcomes Study. This is different from received support , which is a more objective way to look at support. We build that by providing people the opportunities to access social support, but you can’t force it on someone. There may be many factors preventing them from receiving our support. In my thesis, I operationalized received support as the number of volunteer visits a patient has received. It’s a way to measure the times we try to connect, and we should honor each of those as well– even if it doesn’t always work out.

Strategies we’ve learned from our own Resilience can help ground us in a calm, flexible mindset to be our best selves for our patients and our loved ones. It lets us be fully present in the all forms of social support.

Every shift, we share and play a role in the stories of individuals undergoing the most difficult circumstances, week after week. We get to meet patients who rise up to inspire hope in others and cultivate love and beautiful memories through all their pain and suffering. We even get to help them do this. When we are exposed to these stories, or even play a role in them, we experience what’s known as Vicarious Resilience.15 When we get to know others who inspire us and make us think about our own lives, a little bit of their resilience rubs off on us.

I really appreciate you all taking the time and interest to learn about these different psychosocial concepts. I mean, I know y’all are tired enough already from Real School. These concepts may seem new, or intimidating, but if you think about it, you’ve all been doing most of this stuff already. You know what it means to help each other build sandcastles in the face of a looming ocean. You’ve molded yourself into a mighty fine walking stick for people who need help through life’s river crossings. You’ve admired the way that certain fearless spiders like to keep building their webs in the middle of winter.

When We Get To Carry Each Other, we all walk away from this human experience more resilient than before. I believe that every honest interaction in this program is a powerful manifestation of that, and I am so grateful to get to witness you all play a part in it week after week.

References

  1. Mumtaz F, Khan MI, Zubair M, Dehpour AR. Neurobiology and consequences of social isolation stress in animal model—A comprehensive review. Biomedicine & Pharmacotherapy. 2018;105:1205-1222. doi:1016/j.biopha.2018.05.086
  2. Reblin M, Uchino BN. Social and Emotional Support and its Implication for Health. Curr Opin Psychiatry. 2008;21(2):201-205. doi:1097/YCO.0b013e3282f3ad89
  3. Cacioppo S, Grippo AJ, London S, Goossens L, Cacioppo JT. Loneliness: Clinical Import and Interventions. Perspect Psychol Sci. 2015;10(2):238-249. doi:1177/1745691615570616
  4. Ali SM, Merlo J, Rosvall M, Lithman T, Lindström M. Social capital, the miniaturisation of community, traditionalism and first time acute myocardial infarction: a prospective cohort study in southern Sweden. Soc Sci Med. 2006;63(8):2204-2217. doi:1016/j.socscimed.2006.04.007
  5. Quittner A. L., Alpern A. N., Blackwell L. S. (2012). Treatment adherence in adolescents with
    cystic fibrosis. In: Castellani C., Elborn S., Heijerman H. Health Care Issues and
    Challenges in the Adolescent with Cystic Fibrosis. Oxford, UK: Elsevier;. pp. 77–79.
  6. Young, B., Dixon-Woods, Zebrack, B., & Isaacson, S. (2012). Psychosocial care of adolescent
    and young adult patients with cancer and survivors. Journal of Clinical
    Oncology, 30(11), 1221-1226.
  7. Burlew, K., Telfair, J., Colangelo, L., & Wright, E.C. (2000). Factors that influence adolescent
    adaptation to sickle cell disease. Journal of Pediatric Psychology, 25, 287–299.
  8. Waldron, R., Malpus, Z., Shearing, V., Sanchez, M., & Murray, C. D. (2017). Illness, normality
    and identity: the experience of heart transplant as a young adult. Disability and
    rehabilitation, 39(19), 1976-1982.
  9. Pimlott N. The ministry of loneliness. Can Fam Physician. 2018;64(3):166.
  10. Ozbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S. Social Support and Resilience to Stress. Psychiatry (Edgmont). 2007;4(5):35-40.
  11. Lee C-YS, Goldstein SE. Loneliness, Stress, and Social Support in Young Adulthood: Does the Source of Support Matter? J Youth Adolescence. 2016;45(3):568-580. doi:1007/s10964-015-0395-9
  12. Health Behavior and Health Education | Part Three, Chapter Nine: Key Constructs Social Support. https://www.med.upenn.edu/hbhe4/part3-ch9-key-constructs-social-support.shtml. Accessed November 13, 2019.
  13. Lane, Carey D Lee. Module 12: Attraction. In: Essentials of Social Psychology, 1st Edition. 1st ed. Discovering Psychology Series. https://opentext.wsu.edu/social-psychology/chapter/module-12-attraction/. Accessed November 13, 2019.
  14. Wethington E, Kessler RC. Perceived Support, Received Support, and Adjustment to Stressful Life Events. Journal of Health and Social Behavior. 1986;27(1):78-89. doi:2307/2136504
  15. Pack M. Vicarious Resilience: A Multilayered Model of Stress and Trauma. Affilia. 2014;29(1):18-29. doi:1177/0886109913510088

Written by Drew Walker, Streetlight Assistant Director (2019)