Application of the Pennsylvania resilience training program on medical students

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Highlights

  • This study was the first attempt to apply the PRP to Chinese medical students.

  • PRP could change the cognition style of individuals to enhance resilience.

  • PRP could improve the resilience and positive emotions of medical students.

  • PRP should be modified to better adapt to Chinese medical students.

Abstract

This study explored the effects of the Penn Resilience Program (PRP) on the positive and negative emotions, emotion regulation style, and resilience among Chinese medical students. Resilience, positive and negative emotions, and emotional regulation styles scores were compared before and after training through a questionnaire survey. (1) The resilience, positive emotion, and cognitive appraisal scores of the low-resilience experimental group increased significantly after training (P < .05), whereas their negative emotion and expression suppression scores were significantly decreased (P < .05). The positive emotion scores of the high-resilience experimental group increased significantly after training (P < .05), whereas its total scores for negative emotion and expression suppression decreased significantly (P < .05). (2) No significant changes were found in the resilience, positive emotion, negative emotion, cognitive appraisal, and expression suppression scores of the control group (P > .05). PRP could improve the level of resilience and positive emotion for medical students and help them adopt a positive emotion regulation style when facing difficult situations. Our findings laid the groundwork for resilience interventions in the future.

Introduction

Resilience has been a significant research topic since the 1970s, particularly in the field of psychology. It is defined as the capacity to cope effectively with a difficult situation and maintain a healthy disposition in the face of disaster, pain or adversity (Rutter, 1990).

In recent decades, researchers have paid attention not only to the definition and structure of resilience, but to its protective factors as well (Liu, Wang, & Lü, 2013). Some researchers have proposed that resilience consists of internal and external systems. Internal factors refer to psychological factors as well as biological factors that include physical health, genetic predisposition, temperament and gender. External factors refer mainly to the family environment, parenting style, peer relationships and other factors. Internal and external factors interact and influence each other (Ollson, Bond, Burns, Vella-Brodrick, & Sawyer, 2003).

Previous studies had shown that resilience had a moderating effect on the associations between negative life events and mental health problems (Armstrong et al., 2011, Peng et al., 2012, Pinquart, 2009). Students with high resilience could generally maintain mental health when they encounter negative events (Rew et al., 2001, Roy et al., 2011). It is therefore necessary for individuals to improve their resilience for the sake of their mental health. This topic has attracted wide interest among researchers. However, there was no universally accepted resilience training program, so researchers continued to work on resilience training programs for intervention. Waite and Richardson (2004) conducted resilience training (Personal Resilience and Resilient Relationships, PRRR) sessions with 232 workers, covering topics such as self-esteem, controlling forces, life goals, interpersonal relationships and job satisfaction. It was found that the self-esteem, controlling force, life goal and interpersonal relationships of the experimental group were significantly higher than those of the control group after training. Steensma, Den, and Stallen (2007) conducted a 6-month resilience training program on Dutch workers suffering from stress and burnout. Their results showed that the employees exhibited a higher level of effective coping and a lower level of depression under pressure after training, indicating that resilience could be increased through group psychological training.

Several researchers have also begun to focus on student resilience, and have created meaningful training plans. Henderson and Milstein (1996) proposed a “six strategy training program” that entails: (1) providing students with opportunities to participate in activities, such as developing their courage to ask questions and creating activity programs; (2) establishing and maintaining high expectations from students, such as requiring students to accomplish their jobs; (3) creating a caring and supportive climate and establishing trust with them; (4) enhancing pro-social tendencies of students to help them establish healthy relationships with teachers and other students; (5) clarifying behavioral norms and rules for students; (6) teaching students life skills and social skills, including communication skills and problem-solving ability. In addition, Sternberg (2003) proposed the “Another 3R” training program. This model focuses on personal interaction with the environment and how to solve individual problems effectively, and requires students to learn reasoning, build up their resilience, and become more responsible. The International Resilience Research Project (IRRP) proposed the “I am, I have, I can” resilience training strategy based on the psychological characteristics of college students. This program aims to improve the resilience of college students by letting them: (1) find their personal power (personal feeling, attitudes, and beliefs (I am)); (2) find and make full use of their external resources (development of security and feeling of protection (I have)); (3) master their interpersonal skills and problem-solving ability (such as creativity, persistence, humor, and communication (I can)).

Currently, the Penn Resilience Program (PRP) has been put into practice worldwide, which was designed by Seligman and colleagues in Pennsylvania University in 1999. This training plan is based on the cognitive behavioral theory, which focuses on improving students’ cognitive behavior and skills (Kumpfer, 1999). By now, about 19 controlled studies have been conducted to assess the effectiveness of the PRP. These studies have found that the PRP program could relieve anxiety, depression, adjustment disorders and behavioral problems (Giovanni & Elena, 2009). Through Meta analysis, these studies also found that young adults who participated in the PRP showed fewer depressive symptoms and behavior problems, suggesting that they have gained PRP skills through the training. In addition, this training has been applied among officers and soldiers of U.S. Army. The U.S. Army Master Resilience Trainer (MRT) course provides basic resilience skills training as well as instruction in teaching these skills to subordinate soldiers (Reivich & Seligman, 2011).

Nowadays, the Pennsylvania Resilience Program has been used worldwide, but it has not yet been used among Chinese medical students till now. Therefore, the current study applies the PRP training course to Chinese medical students and examines its effects on the resilience, positive and negative emotions, and emotion regulation of medical students.

Section snippets

Participants

A total of 312 students were recruited from the Third Military Medical University in China by means of a public announcement. Every subject completed a separate response booklet with structured and self-reported questionnaires. These questionnaires assessed resilience, positive and negative emotions and emotion regulation styles. According to a plus or minus standard deviation of the average score of the Connor–Davidson Resilience Scale (CD-RISC), the students were divided into high-resilience

Comparison of the resilience, emotion, and emotion regulation style scores of the college students prior to resilience training

The high-resilience students had more positive emotions and tended to use more emotion regulation style of cognitive appraisal, whereas the low-resilience students had more negative emotions and used more expression inhibition frequently. No significant differences in resilience, positive emotion, negative emotion, cognitive appraisal, and expression inhibition scores were found between the control and experimental groups (P > .05) (see Table 2).

Comparison of the resilience, emotion, and emotion regulation style scores of the low-resilience group before and after resilience training

The resilience, positive emotion, and cognitive

Discussion

This study explored the effects of the PRP on the positive and negative emotions, emotion regulation styles, and resilience among Chinese medical students. Compared with the results prior to the training, the resilience, positive emotion, and cognitive appraisal scores of the low-resilience experimental students were significantly increased after training, whereas their negative emotion and expression inhibition scores were significantly reduced. The positive emotion scores of the

Conclusion

This study applied the resilience program of Pennsylvania University to Chinese medical students. The PRP training demonstrated that resilience could be learned and trained. Improving emotional management, communication skills, interpersonal relationships, optimistic thinking, and self-efficacy of students is crucial to the enhancement of their resilience. Emotion regulation style also plays an important role in the resilience of medical students. However, future studies should focus on the

Acknowledgments

We sincerely thank Jonathan R.T. Davidson and Kathryn M. Connor for providing us with original measure of Connor–Davidson Resilience Scale. We are grateful for the generous contributions of the research participants and the staff who assisted with data collection during the study. This study was financially supported by National Natural Science Foundation of China Granted to Min Li (No. 31170994) and Project of Military Research Foundation of PLA of China to Min Li (Grants 12XLZ212 and CWS11J049

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