Prevention via the Promotion of Resilience Skills
Prevention is better than a cure, pretty much everyone would agree with that. The idea is simple – if you can avoid something bad happening, then you won’t have to spend time and effort dealing with the fallout. This is an old wisdom. The Roman poet Persius (A.D.c 58) wrote "Meet the malady on its way." And in 1240 the English Jurist Henry De Bracton penned the proverb "An ounce of prevention is worth a pound of cure. It's more prudent to head off a disaster beforehand than to deal with it after it occurs”.
While public health policy tried to apply this principle, it often lacked the knowledge for how to do it. This began to change as we discovered more about the origins of diseases. Based on the observation that milkmaids were generally immune to smallpox, Edward Jenner pioneered a vaccine for smallpox based on its bovine equivalent, cowpox. This began a process of vaccination that led in 1977 to the global eradication of a human disease for the first time. Cholera is another example. During the 19th century cholera was one of the deadliest diseases in Britain and around the world, killing thousands in a single outbreak. Mainstream thinking at the time was that it was carried by a miasma, or bad air, but a British physician, John Snow (not the character from Game of Thrones), thought it was related to sewage contamination of the water supply. In an outbreak in Soho in 1854, Snow set out to test his theory by meticulously collecting data about who got sick and where (and in the process invented the science of epidemiology). He found a clear relationship between which water pump people had drunk from and who died. He took his findings to the authorities, who removed the pump handle, thereby preventing anyone else becoming sick. More recently examples are indoor smoking to prevent cancers and, of course, the current Covid-19 restrictions are all about preventing further spreading of the disease.
The concept of ‘prevention rather than cure’ has a wider application than just in relation to physical health of course. We find it being used everywhere, from our individual daily lives to international policies on climate change. But while ubiquitous, the process of prevention is not always straightforward. Wherever prevention is applied, the central challenge is the same one that faced Jenner and Snow – what is the underlying process that is causing the problem? If we don’t know this then we can’t prevent it occurring, or at least it will be very difficult to do so.
Today we have higher than ever rates of unhappiness, anxiety and psychological distress in our children and young people. For some these experiences are overwhelming, shrinking their world and blighting their lives. To address this, scientists and practitioners have developed an ever-growing range of interventions and supports, which is great. But while these interventions can and do work, they don’t stem the flow of children struggling in the first place. I’ve worked in NHS mental health services for 25 years and more than ever I hear people saying “I wish we could have started this work years earlier, then we wouldn’t be in this really tough spot”. So, what can be done to prevent these difficulties?
The good news is we now have a better than ever understanding of the origins of psychological health and distress. Indeed, this knowledge lies at the heart of Connect and therefore we believe that Connect will be one of those special interventions that prevents difficulties arising in the first place.
Just to be clear what about this claim, I am not saying psychological pain can be prevented and eradicated completely. To be human is to feel good and bad things. Sometimes bad things happen that are beyond anyone’s control and even when nothing bad happens, our minds can still fill us with sadness, anxiety and shame. These experiences are part of life, as much as hunger, tiredness and thirst. Sure they aren’t nice, but they are inevitable. What we now know is that it’s not these things that drive psychological distress, but how we react to them. If you don’t want to have anxiety or low, then feeling just a little bit of these emotions is something to be anxious or depressed about. Connect does not stop negative experiences, rather teaches children and young people the skills to deal with them when they arise. The research literature is very clear on this – the more we have these core psychological skills, the lower our levels of psychological distress and the higher our quality of life.
Like all skills, psychological skills that deal with the world inside our skin, take practice to develop and become robust. That is why Connect teaches these skills gradually and progressively throughout primary school years. Via a developmentally sensitive curriculum, little by little children learn more and more sophisticated and extended skills for relating to their internal world, identifying what matters to them and then taking steps in those directions.
In Connect we use the DNA-V model, which was developed specifically for children developed by Dr Louise Hayes ( https://www.thrivingadolescent.com/). DNA-V stands for 4 key skills - Discoverer, Noticer, Advisor and Values. On the surface, DNA-V skills are quite straightforward and easy to teach. But this easy usability belies the fact that underneath they are delivering complex psychological processes. It’s like antibiotics. Taking a pill once a day to cure an infection is simple, but the complexity of the bio-medical science that makes this possible is enormous. Likewise, DNA-V is underpinned by some of the most sophisticated and best evidence models in psychological science (see https://contextualscience.org/about_act).
Another unique feature of Connect is how it combines the DNA-V skills with the ‘six ways to wellbeing’ – these are behaviours that psychologically healthy people engage in – https://www.connect-pshe.org/our-approach). Connect teaches DNA-V skills in the context of the six ways to wellbeing, and like a double helix, the two skills mutually support each other and spiral upwards enhancing the child’s resilience and wellbeing.
The evidence shows that when people have and use these keys skills, they are more resilient and better able to stick with things that matter even in the hard times which come to us all. In this way Connect seeks to prevent children, and in time the adults they become, being overwhelmed by their experiences. This won’t prevent the inevitable sadness, anxiety and pain that comes with every rich and fulfilling life, but it can prevent our children from experiencing debilitating levels of psychological distress, and in so doing lay the ground for them to get on and live their lives to the full.
Dr Freddy Jackson Brown is an HCPC (Health and Care Professions Council) registered, chartered clinical psychologist with 20 years experience working with children and families in the NHS. He has published a range of peer reviewed articles / book chapters on ACT, behaviour analysis, disability and sexuality, and Acceptance and Commitment Therapy for Dummies. His interests include child development, language and communication, challenging behaviour, staff systems, emotional literacy and supervision. Freddy is Business Director at Connect PSHE.