Lessons on Emotional Resilience from the Dartmouth PATH Programs
Are you looking for something to do in self-isolation during the coronavirus pandemic? How about completing the same training in emotional resilience used by astronauts?
The PATH Program is an online course developed at Dartmouth College in New Hampshire, USA. During the pandemic, while a lot of us are locked down, it has been made available free of charge to the general public.
It’s not easy for most astronauts to adapt to living for prolonged periods in space, in a confined space, with limited social contact, surrounded by danger. The authors of the PATH program figured that individuals struggling to cope with the stress of self-isolation during the pandemic might benefit from the same kind of psychological techniques used by NASA to prepare astronauts for a mission. It’s already been tested on researchers stationed in the Antarctic, another group facing the stress of isolation in a daunting environment.
Jay Buckley, a professor of medicine at Dartmouth, is one of the creators of the program. As a former NASA astronaut himself, who spent sixteen days in space on the shuttle Columbia, Buckley has first-hand knowledge of these stressors. He recently told The Guardian newspaper:
It’s challenging to be isolated with a small group of people and to not be able to get away. Outer space and your own living room might be drastically different physically, but emotionally the stressors can be the same.
Anyone can now enroll online for the PATH program free of charge. My background is in cognitive-behavioural therapy (CBT) and Stoic philosophy. I’m the author of several books on philosophy and psychology, including a CBT and Stoic philosophy based self-help guide called Build your Resilience. Several people got in touch with me asking me what I thought about the PATH program as a means of developing emotional resilience so I decided to write a quick review.
How the Program Works
There are four main sections and lots of additional resources. You can work through the content at your own pace and select the parts that seem most relevant to you. The main topics covered are:
Mood management for depression
Stress management and resilience-building
The guided self-assessment section is the best place to start if you’re not sure what you need. It takes you through a series of interactive questions. Your responses are used to help you choose which skills you should learn next, e.g., you might be steered toward conflict resolution training if you’re struggling with interpersonal problems.
The conflict resolution part of the course contains videos and online exercises to help you learn basic communication skills designed to help resolve arguments and other problems with other people. The mood management section of the course mainly focuses on an evidence-based approach called problem-solving training (PST), which is very versatile and can be effective in treating certain forms of depression.
The stress management section will help you learn a variety of well-established cognitive-behavioural techniques used for coping with anger, anxiety, and other strong emotions, and for building general emotional resilience. We’ll look at the stress management content in a bit more detail because it’s probably the section that’s going to be of most interest to members of the general public accessing the course.
Stress and Resilience
I’m a big fan of problem-solving training, the approach that’s also used here for depression, so I was glad to see it included in the stress management section as well. Basically all of these techniques fall under the heading of “cognitive-behavioural therapy”, understood in a broad sense. It’s not exactly what you’d do with a cognitive-behavioural therapist but most of these techniques have been used for decades by researchers and clinicians working to help people manage stress and build emotional resilience.
There are other cognitive-behavioural techniques you could learn, e.g., more recent ones that fall under the heading sometimes called “mindfulness and acceptance-based therapy”. The methods taught in this course are pretty well-established, though, and good enough for most people. If you’re more into mindfulness or looking for something a little bit different then you might want to explore other courses. However, the skills taught in here will provide a solid foundation for many people.
The training is moderately thorough but I would think that some people might get a little bit lost in the weeds, if they’re not careful. That’s where the guided self-assessment probably helps because it should direct you toward the parts of the course most relevant to you. You don’t need to complete the whole thing and trying to do so might be overwhelming in some cases. Just focus on the aspects that you think will help you the most. Many people benefit from courses like this just by taking away one concept or technique that really strikes a chord, although learning more may benefit you more.
I actually found this part very interesting because it’s a little bit different from the techniques to which I’m used. It teaches you how to focus attention on an upsetting image for a few minutes and then “compartmentalize” that concern and move your attention on to another task, such as completing a quiz. I find that some therapists have a very simplistic black-and-white attitude that says that any attempt to distract or remove attention from a distressing thought must be bad. That’s absurd, though, because, as the creators of this course understand, it’s completely natural for us to set aside upsetting thoughts sometimes in order to concentrate on other things for a while.
Sometimes other thoughts have to take priority and the ability to compartmentalize our thinking in this way would obviously be essential in a high-stress situation like a space mission. It also serves us well in life generally. For example, we all need to be able to “turn off” worries sometimes to be able to fall asleep at night. If you’re caring for a small child, likewise, you might need to be able to put aside dwelling on upsetting things whenever the child requires your full attention. That’s completely natural but some people are better at doing it than others. You can learn this skill and the simple exercises in this course strike me as a great way of training in it.
Of course, once you’ve learned to set aside upsetting thoughts for a while, you need to be able to come back to them later to ensure you’re not just engaging in unhealthy avoidance. Choosing when and where you think about something is not the same thing as avoidance. Often, though, people find that if they ask themselves “Does this still seem important?” a few hours later the answer may be “not really.” Sometimes our worries seem important at the time but when we come back to them later, in a different frame of mind, they might seem irrelevant, trivial, or easily resolved. Even if that’s not the case, returning to a worry or upsetting memory at a time of your choosing can help you approach it more calmly and rationally, adopting a more constructive perspective. That leads nicely into another stress management approach included here: problem-solving.
Problem-Solving isn’t generally a well-known approach but it’s been around since the early 1970s in the cognitive-behavioural tradition and is supported by a large volume of scientific evidence. It teaches creative and rational approaches to finding solutions, which have an incredibly wide range of applications and are known to help with stressful situations and also in treating clinical depression. Typically, problem-solving training consists in:
Adopting the healthy attitude toward finding solutions, the characteristics of which psychologists have actually managed to define in some detail based on research in this area.
Defining the problem your facing clearly, concisely, and objectively — which is actually, the key step for many people: a problem well-defined is half-solved.
Brainstorming alternative solutions, which you can choose between — again there’s some helpful research in this area and there’s even reason to believe that the ability to do this well and maintain a flexible perspective may reduce stress for some people.
Evaluate those solutions rationally, and there are different methods for doing that, but mainly it involves weighing up the short and long term consequences, the pros and cons of each option.
Carrying out an action plan, by testing out the best solution, or a combination of different options, in practice and then carefully reviewing the results.
Now, there’s a very solid basis for this systematic approach to problem-solving, and each of these steps can be gone into in a lot more depth, drawing on well-established psychological research and various helpful techniques. However, problem-solving can also become overly-laborious sometimes if you try to evaluate everything to the maximum possible degree. Sometimes we need to be able to solve problems more quickly and spontaneously to function well in life. So in my experience, the secret is to learn the (superb) methodology that psychologists have developed over the past half century for rational problem-solving, and maybe practice it several times to acquire skill and confidence in each component, while being prepared to abbreviate it and speed the process up later, if necessary.
Focused Breathing and Guided Muscle Relaxation
There’s less to say about this because it’s such a simple technique but guided audio exercises like the ones in this course are a great way to learn very simple breathing exercises for relaxation. Relaxation techniques in general are not popular at the moment in the field of psychotherapy because there’s concern that clients with severe problems tend to use them too much to suppress feelings of anxiety in an avoidant manner rather than learning to experience them in more healthy ways. However, my belief is that for the majority of people, who are facing mild stress rather than suffering from a diagnosable mental health problem, relaxation techniques are harmless and can be extremely beneficial.
The relaxation method taught here is basically a version of simple abdominal breathing, which is one of the very easiest approaches to learn. It leads naturally into learning the slightly more elaborate process of guided muscle relaxation, which also lends itself very well to being taught through online audio recordings like these. In fact, the two methods are very complementary as learning to relax through abdominal breathing and by relaxing your muscles are distinct techniques but each one tends to make the other easier to learn, with practice. Muscle relaxation is also an old behaviour therapy technique, not exactly cutting edge, but again there’s a large body of scientific evidence going back decades that speaks to its various benefits.
Resilience Through Writing
This is also slightly different from the way we’d normally do things in CBT but this simple approach lends itself to learning resilience online, I think. The idea is just to spend five minutes or so writing in depth about your deepest concerns — whatever stresses you. They’re rightly confident in saying that the very act of writing can, sometimes but not always, be therapeutic. It takes longer to write things down, and requires using your brain differently. That alone can bring out new insights and force you to experience problems from a different perspective.
The caveat I would add is that for some people this might not be the best approach. For example, pathological worriers will sometimes just use writing as a way of over-thinking things. You can help counter that, though, by encouraging yourself when writing to phrase things slightly differently. For instance, often we’ll ask clients to write a description of a problem in more objective language, avoiding strong value judgements or emotive phrases where possible. That can often help you problem-solve and “decatastrophize’ a worrying situation, so that you see it in a more down to earth way. Another mind-trick would be to write a description of a situation as if from the perspective of someone you admire, perhaps even a fictional character, such as someone wiser or more confident.
Exploring different perspectives in writing can help expand our mind in a way that transforms the stress response and it can also help us think of creative solutions. However, the basic method taught in this course is just to focus on writing freely about a stressful event and getting your feelings down on the page, for about 15 minutes a day, over 3–4 days. It’s true that alone will benefit many people.
In psychotherapy we tend to tailor things for individual clients but sometimes I find that actually leads to overcomplicating the process. Research consistently shows that simple exercises of the kind that can be taught in a few minutes, such as some of the ones in this course, can benefit most people, if not everyone. So they’re definitely worth trying, especially if you’re the sort of person who just likes to be told how to do something in plain language so that you can go away, test it out in practice, and experiment with it yourself.
It’s worth going and having a look at the PATH program online, if you’re interested in learning some of these skills. Someone who really immerses themself in these exercises will definitely feel the benefit. Like most elearning, you’ll get back out of it what you put into it. For a lot of people the audio and video will be a novel way of learning psychological exercises. (Although you need to be aware that some of them focus on examples designed for astronauts — such as how to resolve arguments with mission control!)
It might take you roughly half an hour a day for a couple of weeks to complete the course, depending on how much of the content you want to work through. Of course, you can also just dip freely in and out of different sections like I did for my review. There are also PDF manuals you can download and read, containing descriptions of most of the exercises, which some people will find very helpful. If you really want to see the benefit of these type of exercises, though, it does help to treat them a bit like doing physical exercises, such as sit-ups, and set aside at least five or ten minutes for practice each day over the course of a week or two.
If you’re cooped up this is definitely a good way of learning to cope with stress and build your resilience. So, no, you don’t have to be an astronaut to benefit from it!