Helping Ontario's colleges and universities enhance capacity to support student mental health and well-being

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Developing strength-based resilience in students with evidence-informed models

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Promoting mental health encourages the development of resilience. The reverse is also true: promoting resilience leads to better mental health. As resilience involves being able to recover from difficulties or change—to function as well as before and then move forward – students who are resilient can effectively cope with, or adapt to, stress and challenging life situations.

This month’s Spotlight looks at Flourish, speaking with Dr Tayyab Rashid, the lead on this resilience-centered project at the University of Toronto (Scarborough Campus). 


 

CICMH: Flourish is a program that focuses on building resiliency in students early on. Could you give briefly highlight what makes the program stand out, and why it’s received awards and recurring funding?

Tayyab: Basically there’s two things.

First is the reason why we started the program: The rate of mental illness among young adults is increasing, and not only increasing but the issues are becoming more complex. It’s estimated that by 2020, depression will be the leading cause of disability in the developed world. Although I’m trained as a clinical psychologist to treat and diagnose mental illness, I don’t think the most optimal option for tackling mental illness is to treat symptoms. That comes far too late. Most students do not pursue treatment – those who need most are least likely to seek it. This means that we need to take ‘therapy’ out of therapists’ rooms, destigmatize it, and make it more accessible.

The second thing is to help students define their strengths. But to what end? That’s very important. Our aim is to equip the knowledge to our students, and then teach them the skills to use these strengths in difficult times. There are huge swaths of young adults whom, in addition to treatment, would benefit from prevention work. This is 2017 – we need to do mental health better. Mental health needs to be more innovative, more sophisticated, and more effective.

CICMH: Absolutely. The whole model of a student being bumped to a counselor from the get-go to receive therapy and that’s the end of it – it doesn’t seem to be working anymore.

Tayyab: No it isn’t. In fact, if you look at outcome studies you’ll be extremely lucky if the treatment goes very well.

For example, if you go to the best therapist in the world and pay them $300 an hour, they’ll give you evidence-based Cognitive Behavioural Therapy or any other treatment. But even if it’s done very well, the odds of you improving are at most 6/10.

The other issue is that the traditional model of psychotherapy is it only makes you ‘neutral’. Let me explain it this way: It works to reduce your anxiety, sadness and anger from say, a -8 to a -2. Maybe even to ‘neutral’. But is human existence only about coming from depths of depression and anxiety to ‘neutral’? No, I don’t believe so.

It’s a mistaken assumption that if we make our students less sad, their wellbeing and satisfaction will automatically improve. We have to make a concerted effort to integrate and cultivate in students’ knowledge about wellbeing and resilience. So with Flourish, we try to get to students early on, in their first year, and teach them skills that in their next four years will enable them to handle the stressors better.

CICMH: Do you think that the effects Flourish are sustainable? After the students have learned these skills, will it be able to sustain them for the rest of their life?

Tayyab: Good question! I’ve asked that myself. My mind works on a scientific basis, though my heart is with clinical practice.

We are conducting studies that involve 6-month and 12-month follow-ups. We will be to answer that question very soon. We’ve also completed a randomized clinical trial, which compared Flourish-based exercises and Dialectical Behavior Therapy. Both treatments worked well.

So in short, it works. We’re exploring sustainability, and we’re optimistic. The idea is that if someone tells you that you are a kind person, that doesn’t go away easily. It integrates into the sense of self, and knowledge about your strengths is very empowering.

CICMH: I understand that Flourish is built upon the Corey Keyes’ model. Could you explain how you’ve adapted that model to build resiliency in students?

Corey Keyes’ model. Retrieved from https://www.utsc.utoronto.ca/projects/flourish/about/

Tayyab: We took the model theoretically, not empirically. Empirically, Keyes’ has a 14-item measure that describes flourishing and languishing. In Flourish, we have close to 50+ items to assess all those facets.

The part we adapted is that in Keyes’ model, languishing is measured as the absence of wellbeing. In our model, languishing is actually measured with reliable measures that are sensitive to change. So we used separate measures that look at distress and wellbeing.

 

CICMH: How do students participate in Flourish?

Tayyab: Once the students complete the initial Keyes’-based assessment, we invite them to participate in workshops. For students in general, without referrals, we invite them to participate in a 1-day workshop called “The Becoming”. It’s called “The Becoming” because post-secondary education is a process of becoming who you want to be.

The workshop is divided into four different parts. The first part is about enhancing psychological resilience. The second is physical resilience. The third is academic reliance. The last part is building the whole self. With these four parts, wherever a student is in their journey toward flourishing it can be increased and sustained. On the other hand, it also enables students to deal with their sadness using their strengths.

CICMH: What was the initial reception to Flourish?

Tayyab: It actually took us a couple of years to get to where it is now. We wanted to make sure that it was solidly scientific. In the first few years, our focus was just on assessing if states of flourishing/languishing existed – just looking at the constructs. We looked at what the characteristics for flourishing and languishing were in students.

CICMH: Do you have any particular success stories or data to share right now?

We’ve just done a full-year analysis last year. According to that analysis, students who enter university in a flourishing state (ie. High wellbeing, low stress) are four times less likely to have counselling and/or psychiatry visits on average for the next four years, compared to languishing students. This means that the entering state of mind is predictive of lots of things.

For students who are languishing, we have a specific group that we try our best to have them join. It’s an 8-week Strength-Based Resilience (SBR) group that involves assessing their strengths in a more comprehensive way, learning ways to problem-solve through their strengths, and learning “practical wisdom” which is about using strengths in a mindful way. It’s more than just celebrating strengths – it’s also building new strengths and understanding strengths in a more sophisticated way. We found that students who completed the group program had significantly reduced stress levels and increased wellbeing. Our measure of resilience also showed an increase.

CICMH: What about flourishing students?

Tayyab: There is “The Becoming” workshop mentioned earlier available to them, as well as many web-based resources. There are also other workshops provided. It’s really about giving them a sufficient dose, because if they’re not in psychological distress then it’s more important to maintain that or improving it.

We’ve found that those who completed some of our workshops and seminars show a trend toward academic improvement. However, there was an interaction effect – leadership skills. Flourish participants who had greater leadership skills also had greater academic improvement.

Honestly, I have no interest in saying that my program is wonderful. We hear of so many wonderful interventions and there are so many that seem wonderful but are not.

CICMH: Is there anything else exciting happening with Flourish that’s coming up soon?

Yes! There’ve been six universities around the world that have requested dissemination of Flourish’s framework, so come end of June this year any student in the world will be able to go to our website and do the Flourish assessment for free. The best part is that we won’t be tracking any individual information. We’ll be tracking trends in the data, but the data itself is anonymous.

We’ve also secured some additional funding and have a website currently under construction that will provides SBR resources for trainers.


At CICMH, we’d like to thank Dr Tayyab Rashid for his time.

For our readers – to learn more about Flourish, head over to their website.