Houston's M.D. Anderson Cancer Center sees, treats and studies about 80,000 adult and pediatric patients a year. If you ask a doctor there how most patients handle the battle with cancer, you'll find that it's a little like asking how most people handle marriage or getting an MBA.
Depends on the person. And how that person processes anxiety, adversity and stress.
If Lance Armstrong, who found out at 25 that he had testicular cancer, is the cancer patient in question, then it's typical to continue rigorous physical training for the Tour de France even though you've been told you have a less than 50 percent chance of recovery. And then to win the elite international cycling race--seven times.
"No one gets through this life without facing adversity and change," says Dr. Mary Steinhardt, a Fellow in the Lee Hage Jamail Regents Chair in Education at The University of Texas at Austin. "Some people use all of the power they have to recover and create happiness after a bad event--others experiencing the same event may collapse and give up. If you make a C in one of your classes rather than the A you had expected, you can opt to blame the professor or go to a club and drink too much--or you can take action and make a plan for success in the next class you take. Your response to setbacks like this will determine the quality of your life."Steinhardt, who is a professor in the College of Education's Department of Kinesiology and Health Education, is a scholar of bouncing back. She's studied work environments at companies like Dell, Applied Materials, Motorola and 3M to determine what conditions encourage good physical and emotional health in employees. She's also examined ways to prevent teacher stress and burnout, taught military wives at Fort Hood strategies for building resilience and is a licensed professional counselor.According to Steinhardt, whatever inborn traits a person possesses and whatever coping skills he may or may not have gained early in life, most individuals can improve their response to stress by changing the way they think.Steinhardt defines resilience as the ability to bounce back and fully recover from change and stressful situations. A resilient person is strong and flexible and is able to use adverse life situations as an opportunity for growth.Unfortunately, not all of us fit the definition of resilient.When faced with stress, many of us all too quickly give up and feel defeated, as though everything is outside of our control. We decide the situation is hopeless and we blame someone else for our problems. According to Steinhardt, this response is the most harmful to our wellbeing and success.Others of us do a little bit better and put up with the grind. We haven't given up, but we're pretty unhappy and our personal and professional lives usually suffer as we simply try to tolerate the business of living.Some do better still and bounce up, which is a resilient response. Steinhardt states that "bouncing up" means we fully recover from adversity and are back to being ourselves.Then there's the gold medal level of resilience, which Steinhardt refers to as "stepping up." This is when you do whatever it takes to meet a challenge and in the process you advance to an even higher level of functioning and wellbeing. You are thriving rather than just surviving."When we talk about resilient people," says Steinhardt, "we refer to 'the three C's.' These individuals see challenge as an opportunity, not occasion for fight or flight. They have a strong value system and are genuinely committed to the people in their lives and to the activities in which they're involved."And, finally, they have a sense of control and believe they have the power to influence things and make things better--they don't feel like victims and lack initiative. A resilient person is like a tree that's branches are flexible and bend with the wind rather than crack and break under pressure."These days Steinhardt is teaching the potentially lifesaving skill of bending rather than breaking to participants in her newest research project, a study of resilience in African Americans with type 2 diabetes.
Earlier this year she started a Diabetes Coaching Program to see if arming study participants with diabetes self-management skills could reduce the severity of health complications that often accompany the disease. Her study is unique in examining resilience, coping skills and other psychosocial factors that lessen or worsen diabetes-related health problems.
For the first round of classes, Steinhardt recruited 16 East Austin African Americans with type 2 diabetes, and 12 participants completed the program. Recruits attended four weekly two-hour classes at Olivet Baptist Church in East Austin followed by eight bi-weekly hour and a half long support group meetings.
"Type 2 diabetes is almost always preceded by obesity, and recent statistics show that around 45 percent of African Americans are obese and 76 percent are overweight. In addition, type 2 diabetes results in a two to four times higher rate of cardiovascular disease, which is the leading cause of death among African Americans with diabetes.
"People with a chronic disease usually suffer from more stress, worry, anxiety and depression than non-diseased individuals and that stress can lead them to make unhealthy lifestyle choices. The unremitting accumulation of damage is largely preventable--that vicious cycle of an unhealthy lifestyle then facilitating obesity, diabetes and cardiovascular diseases doesn't have to happen."
Since the classes are about learning how good coping skills directly relate to diabetes management, the first hour of each class is devoted to Steinhardt's highly successful "Transforming Lives Through Resilience Education" program. Participants talk about how their week has gone, the emotions they've experienced, stressors they've faced and how their worries have affected their choices. As they become mindful of their unhealthy coping patterns and learn successful life management techniques from Steinhardt, their ability to properly address diabetes management usually improves as well.
"I try to make the abstract into something concrete and leave them with a vivid impression of what's happening inside their bodies," says Steinhardt. "I ask them if they eat fried chicken, for example, and then we look at test tubes that contain the amount of saturated and unsaturated fat, salt and sugar that's in a serving of fried chicken. It stuns most of them.
"Students also learn that blood with too much sugar in it is thicker and has more trouble moving through arteries and capillaries--it may not be able to travel to their eyes, for example, or their extremities. To drive this point home, they suck water through a straw and then try to suck thick corn syrup through a straw. When they have trouble with the corn syrup, the analogy becomes very real for them, and they can picture thick, sugary blood struggling to make it through their arteries."
After the end of each support group meeting, they all go for a walk in the area near Olivet Baptist Church to reinforce the message that exercise is necessary and extremely beneficial. Nutritious foods, in healthy portions, are served in class so that students can get a clear mental picture of what their goal should be outside of class when they sit down to a meal. During each session, Dr. Debra Lopez, a clinical assistant professor in the College of Pharmacy, attends one of the classes and talks to students about the different medicines they may be taking.
"Diabetes is a chronic disease," says Steinhardt, "but we spend time in every class talking about how similar the students are to 'everyone else' as opposed to how different they are. All of us should be eating fruits and vegetables in a variety of colors and eating more whole grains. We all should be exercising, keeping our stress under control and building strong social support networks.
"As with anyone else, when adversity strikes my students, they have an opportunity and choice to handle it well or badly. If they want to grow and become strong, they have to take responsibility for what happens next. They need to focus on what we call an 'empowering interpretation' of the situation. This just means that if they've lost sight in one eye from diabetes-related complications, they can choose to strengthen the resources they do possess, even develop new skills. Perhaps most important, they can opt to connect with other people who light up their life."
According to Steinhardt, one of the best outcomes of the coaching program has been the decision to have students who have completed the program mentor new students. The suggestion came up as part of student feedback offered after the first session, and Steinhardt has had an overwhelmingly positive response from program "graduates" who are eager to be mentors. She's found that the connection between the new students and the students who have walked a mile in their shoes is quite powerful.
"Virginia, a student in my second round of classes who had retinopathy and was blind in her right eye, told me during one class that she was drinking several Cokes a day, which, of course, results in very high daily blood glucose readings. Marcine, a graduate of the first session and a mentor, told Virginia that she should stop drinking those Cokes if she wanted to get better. A social connection had been forged between the two students that encouraged Virginia to attend to Marcine's advice.
"Two weeks later Virginia came in so happy to report that she hadn't had another Coke since then, that she was checking her blood sugar every day and that her blood sugar level had dropped. My hope is that these classes are creating 'health delegates' who will share what they know with friends and neighbors and the message will spread."
To help her students put things in perspective, Steinhardt frequently quotes University of Texas at Austin coaches and turns to sports analogies, comparing a person's response to life stress to a muscle's response to weight training. According to Steinhardt, when you stress a muscle during weight training and then rest, the muscle grows and gets stronger, just as a person will grow psychologically and emotionally if she takes on stress in a healthy way.
Steinhardt even gives her students a guarantee, promising them that if they take responsibility, think in empowering yet realistic ways and create meaningful social connections, situations that used to bother them will not bother them so much and they'll recover faster from adversity.
In addition to learning about stress management and the best techniques for keeping diabetes under control, study participants also get their weight, blood pressure and blood glucose level checked each week during class.
To encourage the continuation of good self-care, Steinhardt gives each student a glucometer to measure their blood sugar on their own and a pedometer to keep track of the number of steps they take each day. Every week when they come to class, Steinhardt downloads the information from the glucometer and pedometer into a computer and gives each student a printout. They then discuss the printout data and set goals for the next week.
"I used to kind of live from finger prick to finger prick," says P. A. Todd, a study participant, "and I always thought of the finger prick as the big event. But what I learned in class was that it's actually the reverse. It's what I do from finger prick to finger prick--the stuff that's in between--that's really important and that can help me get better."
Preliminary results from Steinhardt's first two coaching sessions indicate that participants' diabetes self-management, body mass index, total cholesterol, LDL cholesterol, blood pressure, resilience, perceived stress and fasting blood glucose level improved. With this documented proof of the efficacy of coaching and training, Steinhardt hopes to get much-needed funding so that she can revise her diabetes curriculum, start a train-the-trainer program and continue to conduct classes.
"Funding is always an issue," says Steinhardt, "and I hope we can get the resources to continue this work that we've only begun. I made a promise to the study participants that I wouldn't just walk away after two or three months of classes and leave them and their community. I would like to train others how to teach this material so that we can offer many more classes and help lots of people learn to live happier, healthier lives.
"Right now, I've got burnt orange LiveStrong-style wristbands for sale that say, 'stick with it FOR LIFE' and inspirational cards for sale as well. Each card has a quote that relates to resilience, faith, hope or happiness. Any proceeds I get from the sale of these items will go to fund my research and allow me to continue my mission of helping prevent and manage type 2 diabetes."
Although Steinhardt has spent the majority of her professional career teaching a wide variety of people how to be more resilient, her work with individuals who have diabetes holds a special place in her heart. Her father, a war veteran, was diabetic throughout Steinhardt's childhood and health complications from the disease led to the amputation of both of his legs.
Steinhardt recalls seeing her dad eat anything and everything with gusto when she was growing up, whether it was good for him or not. In a remarkable reversal of his unhealthy lifestyle, he lost weight when he was older, began to travel to veterans' hospitals and homes to offer mentoring and support and when he died he had gotten his diabetes under control.
The story of her dad's diabetes is both a cautionary tale and an inspirational one for Steinhardt. She's ever aware of her genetic predisposition for diabetes but knows, better than most, how much power she has over what happens.
"I'm no different from anybody else," says Steinhardt. "For most of us, it's so much easier to do the bad thing, the negative thing. We're all fragile and vulnerable in the face of stress and adversity. But if we can just hang in there and own all of that power that every single one of us has, oh what opportunities there are to grow."