Jun 8 • 12M

Grit: do you have what it takes?

As resilience, hope, and grit are modifiable should we be identifying people with MS with low levels of these attributes for targeted interventions?

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Arguably one of the most overused terms to emerge during the COVID-19 pandemic has been the term resilience. Journalists and commentators have used the noun ‘resilience’ or the adjective ‘resilient’ when referring to countries, political, educational and healthcare systems, healthcare professionals and individuals with chronic diseases.  These terms are even creeping into biology, for example, (1) his metabolic resilience protected him from developing diabetes and metabolic syndrome; (2) the resilience of the nervous system and its ability to recover function means the onset of the progressive phase of MS will be delayed by several years. 

Resilience /rɪˈzɪlɪəns/
noun
the capacity to recover quickly from difficulties; toughness.
"the often remarkable resilience of so many British institutions"

Resilient /rɪˈzɪlɪənt/
adjective
(of a person or animal) able to withstand or recover quickly from difficult conditions.
"babies are generally far more resilient than new parents realize"

I was therefore not surprised to read the research paper below showing that people with MS (pwMS) with higher resilience and hope scores tended to have higher grit scores. To be honest this is the first time I have heard the term grit applied to multiple sclerosis. 

What is grit?

Grit is defined as ‘perseverance and passion for long-term goals despite adversity’. Grit is essentially a combination of perseverance of efforts and consistency of interests. Perseverance of effort is your ability to continue your efforts even when facing setbacks, while your consistency of interests is your ability to sustain an interest in achieving future goals over time. Higher levels of grit are associated with higher levels of achievements, such as educational attainment and fewer career changes, which go beyond your intrinsic abilities or talent. In general people with higher grit are less likely to drop out of life commitments. Not surprisingly grit is associated with improved health and mental health outcomes, and overall mental wellbeing. 

Other protective factors, including resilience and hope, are also associated with better health and mental health outcomes in people with disabilities. Resilience is a person with MS's ability to achieve growth and flourish in the face of having MS. In comparison, hope is a cognitive state that allows you to work toward your goals and formalise a path to meet your goals. 

So what has this got to do with treating MS? 

The overall conclusion of the study is that as resilience, hope, and grit are potentially modifiable traits, healthcare professionals (HCPs) should prescribe and use interventions to improve them in pwMS. Do you agree or disagree?

How resilient are you? Do you have the necessary grit and hope to maximise your health? Do you know how to make yourself more resilient, hopeful and gritty? 

In the study below resilience and hope seem to explain a significant amount of the variance in grit in pwMS. It shows that pwMS with higher levels of resilience and hope, not surprisingly, had higher grit scores. The obvious question is can you do something about this? I suspect yes. Despite the physical, cognitive, psychological and economic challenges of having MS, it should be possible for pwMS to positively influence their overall wellbeing.

In this study resilience and hope were negatively associated with depression and anxiety. Therefore interventions to enhance resilience should improve mental health outcomes in pwMS. Similarly, hope-based group therapy reduces depression and anxiety in pwMS. Therefore, as part of the holistic management of MS, it is important to boost your resilience, hope and grit levels to maximise your quality of life and long-term outcomes. 

How do you measure resilience, hope and grit?

Your resilience can be measured using the Brief Resilience Scale (BRS) a six-item scale, which assesses your ability to bounce back from stressful events with higher scores representing higher levels of resilience. Hope is measured using the Trait Hope Scale (THS), which is composed of 12 items including items measuring pathway and agency thinking amongst others. Each item is rated on a 4-point Likert scale, ranging from 1 (definitely false) to 4 (definitely true) with higher scores indicating higher hope. Finally, grit can be measured using the Short Grit Scale (Grit-S). It is composed of 8 items that assess your consistency of interest and perseverance of effort with higher scores representing higher levels of grit. 

Treatment

As psychologists consider resilience, hope, and grit to be modifiable we should be identifying pwMS with low levels of these attributes for interventions. Early interventions have shown promising results in improving resilience and mental health outcomes in pwMS. Similarly, hope-based interventions can increase your hope and meaning in life, and reduce anxiety and depression. Finally, interventions to improve grit, for example, cognitive-behavioural therapy (CBT),  mindfulness and value-based or incentivised interventions improve grit by helping you work on your thoughts and behaviours to make sure they are consistent with your long-term goals.

I am going to suggest that HCPs looking after and working with pwMS should routinely screen for low levels of resilience, hope and grit and if necessary promote interventions to improve them with the ultimate aim of enhancing health, in particular mental health, quality of life and psychosocial outcomes. 

I am acutely aware that identifying low levels of resilience, hope, and grit will identify and overlap with several social determinants of health, which may in themselves be potentially modifiable. The latter is something that I am particularly interested in and is why we launched our #ThinkSocial campaign several years ago and why I am so interested in social prescribing. 

For neurologists, the concepts of resilience, hope, and grit will likely be outside their comfort zones, but I simply can’t help thinking that these factors are as important as biological factors in optimising the management of pwMS. The obvious question I have is can pwMS assess their own levels of resilience, hope, and grit and implement self-management strategies to improve them?

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Research Paper  

Lee et al. Examining the Role of Resilience and Hope in Grit in Multiple Sclerosis. Front Neurol. 2022 May 16;13:875133. 

The purpose of this study was to examine the effects of resilience and hope on grit when controlling for demographic covariates, depression, and anxiety in people with multiple sclerosis (MS). This was a cross-sectional study with a sample of 348 participants with MS. Descriptive statistics were performed to examine participants' demographic characteristics. A three-step hierarchical regression analysis was conducted to evaluate the extent to which resilience and hope explain the unique variance in grit while controlling for demographic covariates, depression, and anxiety. Findings suggested that resilience and hope explained a significant amount of variance in grit when controlling for demographic covariates, depression, and anxiety. Furthermore, higher resilience and hope scores were associated with higher grit scores. Given that resilience, hope, and grit are modifiable, rehabilitation and mental health professionals (e.g., psychologists, psychiatrists, rehabilitation counsellors) can integrate strength-based interventions into their practices to bolster resilience, hope, and grit in people with MS. Our paper also has implications for interdisciplinary research and clinical practice.

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General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Barts and The London School of Medicine and Dentistry or Barts Health NHS Trust. The advice is intended as general advice and should not be interpreted as personal clinical advice. If you have problems please tell your own healthcare professional who will be able to help you.