Classrooms are opening this fall, but don't expect it to be anything like a return to pre-pandemic normal. These kids will be bouncing off the walls. They'll squirm in their seats, chat while the teacher is talking, horse around in the hallways, talk back and have a harder time than usual in following rules. "There will be millions of children returning to our classrooms this fall with an over-activated stress physiology," says Nadine Burke Harris, a former pediatrician and expert on childhood stress who is now California's surgeon general.
The last year and a half of COVID-19 craziness has had a cumulative effect on the kids, says Burke Harris. Come September, the sudden change in routine—from more than a year of home confinement and laptop learning to the social pressures of the typical classroom—is likely to unleash a flood of the stress hormone cortisol. Add to that the typical excitement of starting a new school year, even some typically quiet, well-behaved students will be anxious, sad, scared and angry, and these emotions may manifest in the classroom as difficulty paying attention, withdrawal, disruptive behavior and absences.
The potentially explosive first days of school will be a challenge for teachers—and for parents, too, in coping with the emotional and behavioral spillover at home. But it will also provide an opportunity to teach the kids more than multiplication tables and reading assignments. It will be an opportunity to impart a skill that will be important no matter where life takes them: how to bounce back from a difficult experience.
In the coming months, the actions of teachers—along with coaches, pastors, rabbis and, of course, parents—will be crucial in determining which children are able to emerge from the crucible of COVID having strengthened their resilience, an attribute that has been tested in all of us in recent months.
The proper response, Burke Harris wants the nation's educators to know, is not to send the hyper ones to the principal's office or exile them to sit in the corner. Instead, educators should try to help their students understand why their little bodies are revved up and help them develop strategies to calm down and adjust to the new normal.
That's just one recommendation contained in a 438-page report, "Roadmap for Resilience," issued by the California surgeon general last December. It lays out a blueprint for how educators and others should respond to signs of trauma and distress, COVID-related or otherwise, in the months ahead.
Burke Harris is not the only public health official focused on promoting that ineffable psychological quality that gives us the strength to bounce back from adversity, trauma or crisis. As the COVID-19 pandemic winds up its second summer, vaccination rates inch upward, and some of us take our first tentative steps towards normalcy, it remains an open question when the nation's mental well-being will return fully to pre-pandemic levels, how long the traumas and anxiety of the past year and half will linger and when we'll be able to let them go.
COVID-19's legacy of death and destruction won't make it easy—and, if rising caseloads and vaccine hesitancy are any guide, there's still a long way to go. The disease killed more than 600,000 Americans, and left much collateral damage. During the pandemic, an additional 90,000 people died of drug overdoses—a 50 percent increase from pre-COVID levels. Social isolation, economic uncertainty and fear have worn us all down. And though preliminary numbers suggest suicide rates may actually have gone down—a sole bright spot that defied all predictions—many people are still hurting.
According to a report from the Kaiser Family Health Foundation, 41 percent of Americans reported depression or anxiety in January 2021, up from 11 percent in 2019. In another survey, from October 2020, 31 percent of parents said their child's mental or emotional health was worse than before the pandemic. Many kids were irritable, clingy and fearful and had poor appetites and trouble sleeping. Another survey showed that 46 percent of teens had signs of new or worsening mental health conditions since the beginning of the pandemic in March 2020.
The good news is that in recent decades, scientists and psychologists have made great strides in understanding why some people are more resilient than others. What they've learned is encouraging. Resilience, they've found, is not a static quality. We can teach ourselves—and our kids—to become more resilient.
The Neuroscience of Resilience
Although philosophers, authors and armchair psychologists have speculated for centuries on why some people bounce back from adversity quicker than others, it was a 21-year-old graduate student who kick-started the science of resilience. When Martin Seligman arrived in the lab of his supervisor Dick Solomon at University of Pennsylvania in the 1960s, he found that the other researchers in the lab were flummoxed over a problem. The team had been applying electric shocks to the feet of dogs through a metal-plated floor to test how long it would take the pooches to learn to jump over a short barrier to escape the shock. But many of the dogs were not cooperating.
Rather than jumping the barrier, about two-thirds of the dogs gave up after a few shocks, laying down on the floor of the cage and refusing to move. Seligman studied the dogs and eventually coined a term to describe their behavior: learned helplessness. "The animals had learned that nothing they did mattered and, therefore, didn't try to do anything," he says.
Seligman would spend the rest of his career studying not just what it was that caused two-thirds of the dogs to give up, but why the remaining third seemed to be immune from defeat, able to hang in long enough to solve the problem and jump to escape the painful shock.
In the decades that followed, Seligman showed that learned helplessness applied to people, too. He exposed people to an inescapable stressor, such as noise or shock. He found that two-thirds of them entered a state of learned helplessness and many also exhibited symptoms of what would later be called clinical depression. Using questionnaires, Seligman and his team began to hit on an intuitive but powerful answer that explained how the remaining one-third were able to persevere: The most resilient people, he discovered, were optimists.
Since then, neuroscientists have confirmed this assessment by uncovering the brain circuits associated with both psychological resilience and learned helplessness.
Eric Nestler, a neuroscientist at the Icahn School of Medicine at Mount Sinai in New York City, found that mice subjected to stress developed behavioral abnormalities analogous to human depression or post-traumatic stress disorder, which manifested as "anhedonia"—an inability to derive pleasure from sugar water, high-fat foods, the exercise wheel, play, sex and other things that would normally give them pleasure. A smaller group of mice seemed to quickly regain their interest in these delights.
The difference between the two groups came down to a neural circuit that spanned the brain's reward centers; the frontal cortex, which is involved in behavioral control and decision making; and the amygdala and hippocampus, primitive areas involved in memory and emotion. These areas, Nestler explains, are involved in continually watching the environment, remembering its salient features and modifying behavior to adapt.
The resilient mice seemed better at recording the nuances of their trauma, categorizing them, selecting relevant cues and moving on. The less-resilient mice tended to take a specific danger and generalize it, causing them to hunker down even when they didn't need to.
"The animals that are resilient after stress are able to respond to changes in the environment better," says Nestor. "They are a little bit bolder—they are willing to take more chances in order to find the optimal way to function, whereas the susceptible mice just tend to resort to this state of negative avoidance."
Nestler relates these findings back to depression and the way people respond to challenges.
"We all look at the world with rose-colored glasses or gray-colored glasses," he says. "Susceptibility is associated with a more negative outlook and resilience is associated with a more positive outlook. If you have a more positive outlook, you're going to be on the lookout to be more active and nuanced and find ways to navigate through the complexities of life."
Buffering Stress
A predisposition to resilience is partly genetic, psychologists generally agree. But childhood experience plays a key role in shaping our implicit expectations and tuning the neural circuits of the brain. That's where teachers and parents come in.
Nadine Burke Harris worries about how teachers will respond when children return to the classroom and attempt to process all the pandemic-related trauma they have lived through for the last year and half.
Burke Harris, a former pediatrician, began to study the effect of childhood adversity while treating children in the Bayview Section of San Francisco back in the mid-2000s. After noticing many of her sickest patients also came from families experiencing stressors like drug addiction, divorce or mental illness, she began to study the effects of hormones that children released during physical or mental abuse, parental suicide, drug addiction, divorce and other traumas.
Central to her work was the idea that the long-term impact of these stressors could be "buffered" to some extent by our interactions with others. Positive interactions—affection, kindness, laughter and so forth—stimulate benevolent hormones such as oxytocin, a.k.a the "love hormone," which act to turn down the stress response and make us feel safe. These hormones can help shape our perception of the world as a friendly, rather than a hostile place—one that is responsive to our actions, rather than cruelly oblivious to them.
As surgeon general, Burke Harris has made it her mission to train California's health care workforce to screen for adverse childhood experiences (ACEs)—10 family stressors, first identified in the late 1990s, that can elicit a "toxic stress response," a biological cascade driven by the stress hormone cortisol that is linked to a wide range of health problems later in life. In January 2020, she launched an ambitious program, long in the works, to spend $50 million building the infrastructure to train tens of thousands of health care providers to recognize the symptoms of toxic stress in children and their parents and using evidence-based methods of decreasing the stress response and building resiliency.
Just as the program got rolling, the pandemic hit. As things began to shutdown in March, Burke Harris and her colleagues on the state level discussed whether the program should be put on hold; they quickly decided that it was, in fact, more important than ever.
For children there needs to be "as many sources of healing and buffering interactions as possible," the Roadmap report says, as well as interactions that promote a sense of agency—the antithesis of learned helplessness. That starts, she says, with validating the difficulty of the trauma—in this case, the pandemic—while also teaching children that they control their own ability to heal. Adding activities that give the children an opportunity to succeed, such as art, or team sports, can also help. In other words, parents and teachers should listen for signs that children want to talk about their challenges, create a safe space to process what they have gone through and help them find ways to express how they feel about it. If and when children act out, caregivers and teachers should take it as a possible indication that the child is feeling stressed and, rather than immediately administer blame or punishment, help the child calm down.
"Anything that allows people to really make sense of what's happened, make meaning of what's happened" will help, she says. "Resilience is not some thing that kids just have in themselves. It's built from the dozens, if not hundreds of daily interactions with the world. The question is, does that world recognize and respond in a way that supports and promotes resilience? Or does that world respond in a way that simply activates the stress response further?"
What Children and Adults Share
The lessons that scientists and public health officials have learned over the years about resilience in adults holds for kids as well. Interventions that change the way a person thinks about adversity and how it relates to their life story have been shown to strengthen resilience. One of the most ambitious efforts in this regard is a program to help front-line health care workers in New York City cope with the enormous stress of working through COVID-19. The program was started by Dennis Charney, dean of the Icahn School of Medicine at Mount Sinai.
Charney is no stranger to trauma. He has studied resilience for more than 30 years as a psychiatrist and neurobiology researcher (among other things, he led the National Institute of Mental Health's Mood and Anxiety Disorder Research Program). He has interviewed survivors of sexual and physical abuse, patients stricken with congenital diseases, former Vietnam-era prisoners of war and people exposed to other traumas. But he also learned about resilence the hard way, by having to pull himself through his own traumatic experience.
In August 2016, Charney walked out of his hometown deli in Chappaqua, New York with a bagel and iced coffee and encountered a disgruntled former employee with a 20-gauge shotgun. At close range, the weapon ripped open Charney's shoulder, broke a rib, punctured a lung and narrowly missed his liver. He lost half his blood and spent five days in the intensive-care unit at Mount Sinai. (The employee was later sentenced to 28 years in prison.)
"I had been studying resilience all these years," he recalls. "And I said to myself, 'Well, maybe I'm going to find out if I'm a resilient person.'"
In his own recovery, Charney drew on the ideas he had been developing in his research. He sought to cultivate the "realistic optimism" he knew often proves essential in promoting resilience, which involves setting achievable goals during recovery. As a competitive kayaker and weightlifter, Charney framed his rehab in athletic terms: he vowed to compete in a kayak race the following spring and the annual strongest-man competition. Aware that social interaction was among the most powerful buffers to trauma there are, he solicited the support of loved ones and colleagues.
That experience proved invaluable in the spring of 2020, when Charney found himself at the epicenter of the COVID-19 epidemic as it hit New York City, sending the fatality rate of hospitalized patients in as high as 32 percent. At one point, Mount Sinai, a sprawling eight-hospital network, was caring for 2,200 patients, many in a temporary hospital erected in Central Park. The mental health fallout among staff was severe. In a survey of 3360 front-line health care workers in New York City, nearly 40 percent met the clinical criteria for major depression, PTSD or generalized anxiety disorder.
"I knew early on that the stress on our health care workers was going to be enormous," says Charney. "They were seeing death every day. Family members were not allowed to grieve. Our health care workers were not only having the stress of taking care of patients, at some risk to their own health, but also witnessing death and dealing with their own grief in losing so many patients so quickly."
Charney and his colleagues moved quickly to launch the Mount Sinai Center for Stress, Resilience and Personal Growth, a clinic designed to address the "psychosocial" impact of COVID-19 on mental health of front-line health care workers, with a stated goal to "build resilience." The heart of the program is a series of workshops and support groups based on realistic optimism and other ideas that Charney developed.
These ideas inform how children, and their parents and teachers, can cope with this particularly challenging school year.
Perhaps the most effective approach in the program was what Charney calls "reappraisal of the trauma," which entails reflecting on what happened and putting it in a more positive light. "You look at what happened to you. And you realize that you can't undo what happened, but you can reframe it," he says. "You can assimilate it into who you are as a person and move forward."
Charney had found this reappraisal method crucial to his own recovery four years earlier. It allowed him to fight off the reflexive negativity that often follows trauma, which pulls you down and makes you feel helpless. He understood that while his conscious brain might know he was safe, the primitive emotional areas of the brain still needed some convincing. When he returned home from the hospital, he couldn't entirely overcome the irrational feeling that the event might just happen again—for months, he couldn't sleep unless he left a light on.
At Mount Sinai, Charney sought to reframe the experience he and hospital staff shared during the pandemic in a more positive light, and hopefully impart a sense of agency. "This is tough—as tough as it's probably going to get in your career," he told the staff. "But you're going to look back on it with great pride that you were here at this time and this place and look what you accomplished. It's going to help you later in your life when you're faced with other obstacles."
Regaining a sense of control and purpose had been crucial to Charney's own recovery from the gunshot incident. This took the form of coming to forgive his assailant. It was a way to control his reaction to the crisis, and allowed him to follow a compassionate moral compass, which he knew through his research is often associated with resilience. "It helped me feel good about myself that I could forgive and move forward. And it helped me move on. I didn't spend time hating or ruminating about the person who did it. I never did."
With the Mount Sinai staff, Charney and CEO Ken Davis made sure to send out letters thanking them, along with a medallion. The idea was to let them know they were appreciated and that what they did was important.
Advice From Mr. Positive
Charney's approach resonates with the work that Seligman has done since his initial discovery decades ago. He has searched for ways to translate the traits of the optimists into teachable skills—skills that could be taught to children and adults to buffer them against adversity and lower the probability of depression.
Today Seligman is known in the field as the father of "positive psychology," a field of study focused on reverse engineering the psychological traits that allow the healthiest among us to thrive, rather than the traits associated with negative psychological disorders.
Seligman believes psychologists have focused too much on studying resilience in the mentally ill, which is not particularly helpful when it comes to understanding what most people are experiencing during the pandemic, he says. Instead, he has identified two distinct states that people tend to vacillate between: languishing and flourishing.
"The main effect of COVID in the long run now in the United States, has been to lower people's well-being down into the languishing zone, but not really to produce a lot more mental illness," he says.
People who fall into the languishing category exhibit low positive emotion, low engagement, low relationships, low meaning and low achievement—from which Seligman has coined the acronym PERMA. "Languishing is defined not by the presence of high anxiety or high depression," he says, "but by the absence of the positives, the absence of positive emotion, the absence of engagement, the absence of good relationships, the absence of meaning."
Over the last two decades, he says, he and others have developed more than a dozen exercises that have been shown in studies to reliably increase these PERMA characteristics. To help move from languishing to flourishing, he suggests what he calls a "gratitude visit"—an exercise that involves writing a 300-word testimonial to a person who has changed your life, arranging a visit to them (without explaining why) and showing up and reading it to them.
"Typically, both people weep. And typically, your well-being, your PERMA, goes markedly up for about a month. It's been done with thousands and thousands of people. Research shows it works."
Another helpful exercise is to sit down at the end of the day and write down three things that went well that day and why. "We have a catastrophic brain, so we're built to ignore positive events and forget about them and dwell on the catastrophic events. But when people do that, they become more attentive to the positive and, up to six months later, depression and anxiety go down and life satisfaction goes up. It moves people from languishing to flourishing."
Although these exercises might sound hokey, Seligman insists that they are effective in moving people out of the languishing mode—and this success has been validated in large scientific studies.
Human beings are mammals, and the default mammalian response to traumatic events like COVID—a response that has been programmed into the brain by millions of years of evolution—is helplessness. The key to resilience is to overcome this mammalian trait. And often this requires conscious effort to focus on the positive.
As Seligman points out, COVID-19 can't be worse than the Black Plague, which killed as many as 200 million people in the 14th century. Back then, people had no idea what was going on and probably felt that there was no way out—a recipe for learned helplessness on a massive scale. But as bad as the Black Plague was, he points out, it eventually led to something positive: the Renaissance.
As kids and their parents struggle with what this difficult phase of the pandemic, it's worth remembering that making a conscious effort to look for what's positive in this ordeal may be our most effective weapon against its debilitating effects.
"I think we underestimate how resilient people are," says the incorrigibly optimistic Seligman. "I think we're on our way out."
Correction (8/26): This article was changed to correct the spelling of Mount Sinai CEO Ken Davis' name.
