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Post-traumatic growth

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Post-traumatic growth (PTG) or benefit finding refers to positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning.[1] These sets of circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to individuals' way of understanding the world and their place in it.[1] Posttraumatic growth is not about returning to the same life as it was previously experienced before a period of traumatic suffering; but rather it is about undergoing significant 'life-changing' psychological shifts in thinking and relating to the world, that contribute to a personal process of change, that is deeply meaningful.[1]

It is often characterized by decreased reactivity and faster recovery in response to similar stressors in the future. This occurs as a result of exposure to the event and subsequent learning. It is associated with the positive psychology movement. The term was coined by psychologists Richard G. Tedeschi and Lawrence G. Calhoun at the University of North Carolina at Charlotte in the mid-nineties.[2] According to Tedeschi as many as 90 percent of survivors report at least one aspect of posttraumatic growth, such as a renewed appreciation for life.[3] Traditional psychology's equivalent to thriving is resilience, which is reaching the previous level of functioning before a trauma, stressor, or challenge. The difference between resilience and thriving is the recovery point. Thriving goes above and beyond resilience. Thriving finds benefits within challenges.[4]

History

The general understanding that suffering and distress can potentially yield positive change is thousands of years old.[1] For example, some of the early ideas and writing of the ancient Hebrews, Greeks, and early Christians, as well as some of the teachings of Hinduism, Buddhism, Islam[5] and the Baha'i Faith[6] contain elements of the potentially transformative power of suffering. Attempts to understand and discover the meaning of human suffering represent a central theme of much philosophical inquiry and appear in the works of novelists, dramatists and poets.[5] Scholarly interest in post-traumatic growth began to gain considerable strength in the 1990s, based on the idea that greater interest should be placed on studying people who are actually healthy, and the better and brighter aspects of human behavior.[1] Today, there is overwhelming evidence that individuals facing a wide variety of very difficult circumstances experience significant changes in their lives as a result, many of which they view as highly positive.[1] Posttraumatic growth has been documented in relation to various natural and human-made traumatic events, including life-threatening disease, war, abuse, immigration and death of loved ones.[7][8] It has also been documented in many countries and in the context of different cultures with evidence that PTG is a universal phenomenon but also manifests some cultural variations.[7] Growth from trauma has been conceptualized not only for individuals but also for families as systems.[9]

Causes

Posttraumatic growth occurs with the attempts to adapt to highly negative sets of circumstances that can engender high levels of psychological distress such as major life crises, which typically engender unpleasant psychological reactions.[1] Growth does not occur as a direct result of trauma, rather it is the individual's struggle with the new reality in the aftermath of trauma that is crucial in determining the extent to which posttraumatic growth occurs.[1] Encouragingly, reports of growth experiences in the aftermath of traumatic events far outnumber reports of psychiatric disorders, since continuing personal distress and growth often coexist.[1]

As far as predictors of Post-Traumatic Growth, a number of factors have been associated with adaptive growth following exposure to a trauma. Spirituality has been shown to highly correlate with post-traumatic growth and in fact, many of the most deeply spiritual beliefs are a result of trauma exposure (O'Rourke 2008). Social support has been well documented as a buffer to mental illness and stress response. In regards to Post-Traumatic Growth, not only is high levels of pre-exposure social support associated with growth, but there is some neurobiological evidence to support the idea that support will modulate a pathological response to stress in the Hypothalamic-Pituitary-Adrenocortical (HPA) Pathway in the brain (Ozbay 2007). As Richard G. Tedeschi and other posttraumatic growth researchers have found, the ability to accept situations that cannot be changed is crucial for adapting to traumatic life events. They call it “acceptance coping,” and have determined that coming to terms with reality is a significant predictor of posttraumatic growth.[10] It is also alleged, though currently under further investigation, that opportunity for emotional disclosure can lead to post-traumatic growth though did not significantly reduce post-traumatic stress symptomology (Slavin-Spenny 2010). Gender roles did not reliably predict post-traumatic growth though are indicative of the type of trauma that an individual experiences. Women tend to experience victimization on a more individual and interpersonal level (e.g. sexual victimization) while men tend to experience more systemic and collective traumas (e.g. military and combat). Given that group dynamics appear to play a predictive role in post-traumatic growth, it can be argued that the type of exposure may indirectly predict growth in men (Lilly 2012).

Characteristics

Results seen in people that have experienced posttraumatic growth include some of the following: greater appreciation of life; changed sense of priorities; warmer, more intimate relationships; greater sense of personal strength; and recognition of new possibilities or paths for one's life and spiritual development.[11] Two personality characteristics that may affect the likelihood that people can make positive use of the after-math of traumatic events that befall them include extraversion and openness to experience.[12] Also, optimists may be better able to focus attention and resources on the most important matters, and disengage from uncontrollable or unsolvable problems.[1] The ability to grieve and gradually accept trauma could also increase the likelihood of growth.[1] It also benefits a person to have supportive others that can aid in post-traumatic growth by providing a way to craft narratives about the changes that have occurred, and by offering perspectives that can be integrated into schema change.[13] These relationships help develop narratives; these narratives of trauma and survival are always important in post-traumatic growth because the development of these narratives forces survivors to confront questions of meaning and how answers to those questions can be reconstructed.[14] Individual differences in coping strategies set some people on a maladaptive spiral, whereas others proceed on an adaptive spiral.[15] With this in mind, some early success in coping could be a precursor to posttraumatic growth.[15] A person's level of confidence could also play a role in her or his ability to persist into growth or, out of lack of confidence, give up.[1]

A recent article by Iversen, Christiansen & Elklit (2011) suggests that predictors of growth have different effects on PTG on micro-, meso-, and macro level, and a positive predictor of growth on one level can be a negative predictor of growth on another level. This might explain some of the inconsistent research results within the area.[16]

Theories and findings

To understand the significance of thriving in the human experience, it is important to understand its role within the context of trauma and its separation from traditional psychology’s idea of resilience. Implicit in the idea of thriving and resilience both is the presence of adversity. O'Leary and Ickovics created a four-part diagram of the spectrum of human response to adversity, the possibilities of which include: succumbing to adversity, surviving with diminished quality of life, resiliency (returning to baseline quality of life), and thriving.[17] Thriving includes not only resiliency, but an additional further improvement over the quality of life previous to the adverse event.

In general, research in psychology shows that people are resilient overall. For example, Southwick and Charney, in a study of 250 prisoners of war from Vietnam, showed that participants developed much lower rates of depression and PTSD symptoms than expected.[18] Meichenbaum found that while 50-60% of North Americans will experience trauma, only 5-10% generally develop symptoms of PTSD. Similarly, 68 million women of the 150 million in America will be victimized over their lifetime, but only 10% will suffer insofar as they must seek help from mental health professionals.[19]

In general, traditional psychology’s approach to resiliency as exhibited in the studies above is a problem-oriented one, assuming that PTSD is the problem and that resiliency just means to avoid or fix that problem in order to maintain baseline well-being. This type of approach fails to acknowledge any growth that might occur beyond the previously set baseline, however. Positive psychology’s idea of thriving attempts to reconcile that failure. A meta-analysis of studies done by Shakespeare-Finch in this area indicates that there is actually an association between PTSD symptoms and posttraumatic growth. The null hypothesis that there is no relationship between the two was rejected for the study. The correlation between the two was significant and was found to be dependent upon the nature of the event and the person’s age. For example, survivors of sexual assault show less posttraumatic growth than survivors of natural disaster. Ultimately, however, the meta-analysis serves to show that PTSD and posttraumatic growth are not mutually exclusive ends of a recovery spectrum and that they may actually co-occur during a successful journey to thriving.[20]

Thriving in positive psychology definitely aims to promote growth beyond survival, but it is important to note that some of the theories surrounding the causes and effects of it are more ambiguous. Literature by Carver indicates that the concept of thriving is a difficult one to define objectively. He makes the distinction between physical and psychological thriving, implying that while physical thriving has obvious measurable results, psychological thriving does not as much. This is the origin of much ambiguity surrounding the concept. Carver lists several self-reportable indicators of thriving: greater acceptance of self, change in philosophy, and a change in priorities. These are factors that generally lead a person to feel that they have grown, but obviously are difficult to measure quantitatively.[4]

The dynamic systems approach to thriving attempts to resolve some of ambiguity in the quantitative definition thriving, citing thriving as an improvement in adaptability to future trauma based on their model of attractors and attractor basins.[4] This approach suggests that reorganization of behaviors is required to make positive adaptive behavior a more significant attractor basin, which is an area the system shows a tendency toward.

Another attempt at quantitatively charting the concept of thriving was done by Meichenbaum, who composed a Post-Traumatic Growth Inventory. The inventory has 21 items and is designed to measure the extent to which one experiences personal growth after adversity. The inventory includes elements from five key areas: relating to others, new possibilities, personal strength, spiritual change, and appreciation for life.[21] These five categories are reminiscent of the subjective experiences Carver struggled to quantify in his own literature on thriving, but are imposed onto scales to maintain measurability. When considering the idea of thriving from Meichenbaum’s five-point approach, it is easier to place more research from psychology within the context of thriving.

One of the key facets of post-traumatic growth set forth by Meichenbaum is relating to others. Accordingly, much work has been done to indicate that social support resources are extremely important to the facilitation of thriving. House, Cohen, and their colleagues indicate that perception of adequate social support is associated with improved adaptive tendency. This idea of better adaptive tendency is central to thriving in that it results in an improved approach to future adversity. Similarly, Hazan and Shaver reason that social support provides a solid base of security for human endeavor. The idea of human endeavor here is echoed in another of Meichenbaum's facets of post-traumatic growth, new possibilities, the idea being that a person’s confidence to "endeavor" in the face of novelty is a sign of thriving.[4]

Concurrent with a third facet of Meichenbaum's post-traumatic growth, personal strength, a meta analysis of six qualitative studies done by Finfgeld focuses on courage as a path to thriving. Evidence from the analysis indicates that the ability to be courageous includes acceptance of reality, problem-solving, and determination. This not only directly supports the significance of personal strength in thriving, but can also be drawn to Meichenbaum's concept of "new possibilities" through the idea that determination and adaptive problem-solving aid in constructively confronting new possibilities. Besides this, it was found in Finfgeld's study that courage is promoted and sustained by intra- and interpersonal forces, further supporting Meichenbaum's concept of "relating to others" and its effect on thriving.[22]

On Meichenbaum's idea of appreciation for life, research done by Tyson on a sample of people 2–5 years into grieving processing reveals the importance of creating meaning. The studies show that coping with bereavement optimally does not only involve just "getting over it and moving on", but should also include creating meaning to facilitate the best recovery. The study showed that stories and creative forms of expression increase growth following bereavement.[23] This evidence is supported strongly by work done by Michael and Cooper focused on facets of bereavement that facilitate growth including "the age of the bereaved", "social support", "time since death", "religion", and "active cognitive coping strategies".[4] The idea of coping strategies is echoed through the importance thriving places on improving adaptability. The significance of social support to growth found by Michael and Cooper clearly supports Meichenbaum's concept of "relating to others". Similarly, the significance of religion echoes Meichenbaum's "spiritual change" facet of post-traumatic growth.

In general, as pointed out by Carver, the idea of thriving seems to be one that is hard to remove from subjective experience. However, work done by Meichenbaum to create his Post-Traumatic Growth inventory helps to set forth a more measurable map of thriving. The five fields of post-traumatic growth that Meichenbaum outlined include: relating to others, new possibilities, personal strength, spiritual change, and appreciation for life. Though literature that addresses "thriving" specifically is sparse, there is much research in the five areas Meichenbaum cites as facilitating thriving, all of which supports the idea that growth after adversity is a viable and significant possibility for human well-being.

Applications

In contrast to resilience, hardiness, optimism, and a sense of coherence, post-traumatic growth refers to a change in people that goes beyond an ability to resist and not be damaged by highly stressful circumstances; it involves a movement beyond pre-trauma levels of adaptation.[1] It could be possible that people who are highest on these dimensions of coping ability will report relatively little growth.[1] That is because these people have coping strategies that will allow them to be less challenged by trauma, and the struggle with trauma may be crucial for post-traumatic growth.[1]

Conclusion

Posttraumatic growth is facilitated by relating to others, new possibilities, personal strength, spiritual change, and appreciation for life. Future research may include longitudinal studies to help validate thriving as an actual self-improvement, as opposed to a perceived self-improvement. Specifically, the sub-field of personality psychology is being called upon to study posttraumatic growth to help validate it as a legitimate personality change.[24] Further validation may come from using control groups for comparisons.[25] In sum, comparative longitudinal studies may help solidify thriving’s place in the fields of health and psychology.

See also

References

  1. ^ a b c d e f g h i j k l m n o Tedeshi, R.G., & Calhoun, L.G. (2004). Posttraumatic Growth: Conceptual Foundation and Empirical Evidence. Philadelphia, PA: Lawrence Erlbaum Associates.
  2. ^ Michaela Haas, "Bouncing Forward: Transforming Bad Breaks into Breakthroughs," Atria/Enliven, 2015
  3. ^ Michaela Haas. "What is Posttraumatic Growth?".
  4. ^ a b c d e Carver, C. "Resilience and Thriving: Issues, Models, and Linkages". Journal of Social Issues. 54: 245–266. doi:10.1111/j.1540-4560.1998.tb01217.x.
  5. ^ a b Tedeschi, R.G., & Calhoun, L.G. (1995). Trauma and Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, CA: Sage.
  6. ^ Abdu'l-Bahá on Suffering and Tests, Baha'i International Community, accessed Jul 14 2013.
  7. ^ a b Berger, R. & Weiss, T. (2006). Posttraumatic Growth in Latina Immigrants. Journal of Immigrant and Refugee Studies, 4, 55-72
  8. ^ Linley, P.A. and Joseph, S. (2004). Positive Change Following Trauma and Adversity: A Review. Journal of Traumatic Stress, 17, 11–21
  9. ^ Berger, R. & Weiss, T. (2008, November 18). The Posttraumatic Growth Model: An Expansion to the Family System, Traumatology
  10. ^ Michaela Haas, Bouncing Forward:Transforming Bad Breaks into Breakthroughs, Atria/Enliven, 2015, ISBN 150111512X
  11. ^ Tedeshi, R.G., & Calhoun, L.G. (1996). The Posttraumatic Growth Inventory: Measuring the Positive Legacy of Trauma. Journal of Traumatic Stress, 9. 455-471.
  12. ^ Costa, P.T., & McCrae, R.R. (1992). Normal Personality Assessment In Clinical Practice: The NEW Personality Inventory. Pscyhological Assessment, 4. 5-13.
  13. ^ Neimeyer, R.A., (2001). Meaning Reconstruction and the Experience of Loss. Washington, DC: American Psychological Association.
  14. ^ McAdams, D.P., (1993). The Stories We Live By: Personal Myths and the Making of the Self. New York: Morrow.
  15. ^ a b Aldwin, C.M., (1994). Stress, Coping, and Development. New York: Guilford.
  16. ^ Iversen, T.N., Christiansen, D.M., & Elklit, A. (2011b). Forskellige prædiktorer for posttraumatisk vækst på mikro-, meso-, og makroniveau. Psyke & Logos, 2011-2.
  17. ^ O'Leary, V.; Ickovics, J. (1995). "Resilience and thriving in response to challenge: An opportunity for a paradigm shift in women's health". Women's Health: 121–142.
  18. ^ Southwick, S.; Charney, D. (2012). "he Science of Resilience: Implications for the Prevention and Treatment of Depression". Science. 338: 79–82. doi:10.1126/science.1222942.
  19. ^ Tan, S. (2013). "Resilience and posttraumatic growth: Empirical evidence and clinical applications from a christian perspective". Journal of Psychology and Christianity. 32 (4): 358–364.
  20. ^ Shakespeare-Finch, J.; Lurie-Beck, J. (2014). "A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder". Journal of Anxiety Disorders. 28 (2): 223–229. doi:10.1016/j.janxdis.2013.10.005.
  21. ^ Meichenbaum, D.; Calhoun, L. G.; Tedeschi, R. G. (2006). Handbook of post- traumatic growth: Research and practice. Mahwah, NJ: Lawrence Erlbaum. pp. 355–368.
  22. ^ Finfgeld, D. L. (1999). "Courage as a process of pushing beyond the struggle". Qualitative Health Research. 9 (6): 803–814. doi:10.1177/104973299129122298.
  23. ^ Tyson, J. (2013). "Turning a tragedy into a tribute: A literature review of creating meaning after loss of a loved one". Illness, Crisis, & Loss. 21 (4): 325–240. doi:10.2190/IL.21.4.e.
  24. ^ Jayawickreme, E.; Blackie, L. E. R. (2014). "Post‐traumatic growth as positive personality change: Evidence, controversies and future directions". European Journal of Personality. 28 (4): 312–331. doi:10.1002/per.1963.
  25. ^ Michael, C.; Cooper, M. (2013). "Post-traumatic growth following bereavement: A systematic review of the literature". Counseling Psychology Review. 28 (4): 18–33.

Bibliography

  • O'Rourke, J., Tallman, B., & Altmaier, E. (2008). Measuring Post-Traumatic Changes in Spirituality/Religiosity. Mental Health, Religion, & Culture. Vol 11, 719-728.
  • Ozbay, F., Johnson, D., Dimoulas, E., Morgan, C., Charney, D., & Southwick, S. (2007). "Social Support and Resilience to Stress: From Neurobiology to Clinical Practice." Psychiatry, May 2007, 35-40.
  • Haas, Michaela (2015). Bouncing Forward: Transforming Bad Breaks into Breakthroughs. Atria/Enliven, 2015, ISBN 150111512X.
  • Slavin-Spenny, O.; Cohen, J.; Oberleitner, L.; Lumley, M. (2010). "The Effects of Different Methods of Emotional Disclosure: Differentiating Post-Traumatic Growth from Stress Symptoms". Journal of Clinical Psychology. 67: 993–1007. doi:10.1002/jclp.20750.
  • Lilly, M.; Valdez, C. (2012). "Interpersonal Trauma and PTSD: The Roles of Gender and a Lifespan Perspective in Predicting Risk". Psychological Trauma: Theory, Research, Practice, and Policy. 4: 140–144. doi:10.1037/a0022947.
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