7 CLIENT’SRESPONSE TOILLNESS 139
(although hardiness did not seem to be related to
adaptation to hypertension or arthritis). Lambert
(1990) found that hardiness was a significant predic-
tor of psychological well-being and social support for
women with rheumatoid arthritis.
Although hardiness has been described as a trait,
some researchers believe that education can increase
health-related hardiness. Webster and Austin (1999)
conducted research in which people who believed that
stress was affecting their lives participated in a study
designed to improve their abilities to manage stress.
They were referred by local health providers, thera-
pists, and physicians or obtained information about
the study through newspaper advertisements or lit-
erature at the local mental health center. The Well-
ness Program focused on identifying and managing
feelings, developing coping strategies, taking time
for oneself, and improving communication. After the
education groups, the researchers found that the
participants had increased control and commitment
(hardiness components) and significantly reduced
symptoms such as obsessive-compulsive behaviors,
hostility, withdrawal/isolation, and level of distress.
Some believe that the concept of hardiness is
vague and indistinct and may not help everyone. Some
research on hardiness suggests that its effects are
not the same for men and women (Benishek & Lopez,
1997) and that hardiness is a better stress moderator
in men. Low (1999) suggested that hardiness may be
useful only to those who value individualism such
as people from some Western cultures. For people
and cultures who value relationships over individ-
ual achievement, hardiness may not be beneficial.
Resilience and Resourcefulness
Two closely related concepts, resilience and resource-
fulness, help people to cope with stress and to mini-
mize the effects of illness. Resilienceis defined as
having healthy responses to stressful circumstances
or risky situations (Hill, 1998). This concept helps to
explain why one person reacts to a slightly stressful
event with severe anxiety, while another person does
not experience distress even when confronting a
major disruption (Krafcik, 2002; Harris, 2001). Stud-
ies on resiliency first focused on factors that resulted
in positive outcomes for children who were at risk
because their parents had alcohol or mental health
problems (Rutter, 1987). Factors that enhanced out-
comes were children’s abilities to develop self-esteem
and self-efficacy through relationships with others,
have new experiences, and obtain assistance with life
transitions as they matured.
Studies have found that families who use their
strengths show improved resiliency and more posi-
tive outcomes than families who view themselves
as victims of multiple problems such as poverty, un-
employment,and low socioeconomic status. Hill (1998)
identified family protective mechanisms that improved
the resiliency of children including instilling positive
family values, promoting positive communication and
social interaction, maintaining flexible family roles,
exercising control over children, and providing aca-
demic support to children. Other family protective
factors that have been shown to improve the re-
siliency of adolescents include caring and supportive
relationships with adult caregivers; high expecta-
tions for good citizenship, academic achievement,
and spiritual involvement; and encouragement to
participate in caring for siblings, household chores,
part-time work, and carefully selected, safe activities
outside the home (Calvert, 1997).
Resourcefulnessinvolves using problem-solving
abilities and believing that one can cope with adverse
or novel situations. People develop resourcefulness
through interactions with others, that is, through
successfully coping with life experiences (Krafcik,
2002). Examples of resourcefulness include performing
health-seeking behaviors, learning self-care, monitor-
ing one’s thoughts and feelings about stressful situa-
tions, and taking action to deal with stressful circum-
stances (Harvard Women’s Health Watch, 2001).Spirituality
Spiritualityinvolves the essence of a person’s being
and his or her beliefs about the meaning of life and
the purpose for living. It may include belief in God or
a higher power, the practice of religion, cultural be-
liefs and practices, and a relationship with the envi-
ronment. Although many clients with mental dis-
orders have disturbing religious delusions, for many
in the general population, religion and spirituality
are a source of comfort and help in times of stress or
trauma. Studies have shown that spirituality is a
genuine help to many mentally challenged adults,
serving as a primary coping device and a source of
meaning and coherence in their lives or helping to
provide a social network (Fallot, 2001).
Religious activities such as church attendance
and praying and associated social support have been
shown to be very important for many people and are
linked with better health and a sense of well-being
(Baetz et al., 2002). These activities also have been
found to help people cope with poor health. Hope and
faith have been identified as critical factors in psy-
chiatric as well as physical rehabilitation (Lunt, 2001;
Musgrave et al., 2002; Adams & Partee, 1998).
Studies have shown that religion and spiritual-
ity can be helpful to families who have a relative with
mental illness: religion was found to play an impor-