Commentary

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The concept of posttraumatic growth is centuries old, but only recently has it been introduced into the fields of psychology and psychiatry as a scientifically based construct.  The term was first discussed in the literature in 1995 by psychologists Richard Tedeschi and Lawrence Calhoun. Through their work with bereaved parents, they noted that many parents developed positive changes as a result of their psychological struggle following the loss of their children. Over several decades of research, it became evident that many individuals who suffer various types of trauma experience psychological growth.   

 

The term posttraumatic growth is often used interchangeably with psychological resilience. Although there are some similarities, the two are separate and distinct psychological processes. Individuals who are labelled as “resilient” tend to be relatively unaffected by the effects of trauma, at least to a significant degree. In fact, resilient individuals tend to bounce back quickly when faced with adversity. The process and outcome of posttraumatic growth is generally seen in people who are not resilient, but rather struggle psychologically following the aftermath of their trauma. In essence, they are trying to survive and not be overtaken by the negative effects of trauma. As individuals begin to reconstruct their beliefs about life, themselves, and others, they come to appreciate the fact that they have become stronger, developed a greater capacity for relating to others, experience immense gratitude, acknowledge new possibilities, and experience spiritual and/or existential growth.

 

In recent years, the wars in Iraq and Afghanistan have brought greater focus to the formal psychiatric disorder of posttraumatic stress disorder or PTSD. First recognized as a formal psychiatric condition following the Vietnam war, PTSD is generally viewed as the consequence of single or repeated traumatic events. Indeed, acknowledging PTSD as a possible outcome of trauma is important, however, the reality is that being overly focused on PTSD can blind us to the fact that many trauma survivors also experience posttraumatic growth. The same difficult experiences that lead to PTSD set the stage for psychological growth. Our beliefs about ourselves, others, and how life is supposed to work no longer seem to resonate. In fact, many people experience symptoms of PTSD and posttraumatic growth at the same time. It is the notion that from loss there can be gain, which is one of the paradoxes of posttraumatic growth.

 

Just like PTSD, posttraumatic growth is not reserved exclusively for combat veterans. Those who have endured natural disasters, sexual violence, motor vehicle accidents, domestic violence, and many other types of trauma also experience posttraumatic growth. The best examples of posttraumatic growth are those individuals who have faced adversity of all sorts, developed new perspectives about life, and shared the lessons they have learned with others. These are what we often refer to as “everyday heroes”. They are men and women who have faced incredible adversity and go on to help others learn to grow from their struggles as well.

 

Research Support for PTG

 

A recent comprehensive review of the literature was done by Tedeschi, Shakespeare-Finch, Taku, and Calhoun (2018), which revealed hundreds of published studies on posttraumatic growth in the psychological and psychiatric literature, as well as many more within the fields of sociology, religion, and others. Much of the literature within psychology utilized the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996; Tedeschi, Taku, Senol-Durak, & Calhoun, 2017) as a measure of the construct. The PTGI has been translated into more than twenty languages (Tedeschi, et al., 2018), which supports the idea that posttraumatic growth has universal presence.

 

There are five domains of PTG that have been established through factor analyses and replicated in dozens of studies through the use of the PTGI (Tedeschi & Calhoun, 1996; Brunet, McDonough, Hadd, Crocker, & Sabiston, 2010; Lee, Luxton, Reger, & Gahm, 2010; Linley, Andrews, & Joseph, 2007; Taku, Cann, Calhoun, & Tedeschi, 2008). These domains include: 1) relationship with others; 2) personal strength; 3) new possibilities; 4) appreciation of life; and 5) spiritual and existential change. It is important to note that people often experience growth in multiple areas.

 

Relationship with Others

 

In this domain of PTG, people report that their relationships have a deeper emotional quality. They are more open to others and willing to disclose information about themselves. They are also more respectful and compassionate toward others. Often these changes arise as a result of the person disclosing about their trauma. This is generally not disclosure that takes place in a formal therapeutic relationship, but rather through natural discourse with friends, family members, clergy, or other trauma survivors. 

 

Personal Strength

 

People are often surprised by their strength as they struggle with unthinkable tragedy. They start out with the goal of surviving, but find an inner fortitude that they were unaware existed. It is important to note, however, that people do not set out to experience growth following tragedy. It develops over time. As they learn to manage their distress and reconstruct their core belief system, they are more confident in their abilities to handle new adversities that may come their way.

 

New Possibilities

 

Trauma involves loss of some kind. It may be the loss of a relationship, a sense of belonging, a particular physical ability, or one’s belief about what their future will look like. In the place of losses such as these, people find other ways to live that are fulfilling. These possibilities are often ones that would have never been considered before the trauma.

 

Appreciation of Life

 

Trauma often causes a person to consider their mortality, which can lead to an appreciation for the delicateness and fleetingness of life. After experiencing a trauma, small things in life take on new meaning and provide a sense of satisfaction that was not there before.

 

Spiritual and Existential Change

 

Trauma leads to many questions, often questions of a religious and/or existential nature.   Questions about purpose and meaning take on new importance. In cases where interpersonal transgressions (infidelity, physical harm, betrayal, etc.) are associated with the trauma, PTG is often related to forgiveness, religiosity, and spirituality (Schultz, Tallman, & Altmaier, 2010).

 

The current process model of PTG is found in Tedeschi, et.al, (2018), and can be briefly summarized. This model begins with the idea that people develop an assumptive world (Janoff-Bulman, 1992) or core belief system that is culturally influenced and individualized. Life events are potentially disruptive to this set of core beliefs, and can act as psychologically seismic events that create emotional distress due to the inability to clearly understand or find meaning in what has occurred. Trauma therefore is defined according to the disruption of the core belief system. On the other hand, people whose core belief system provides understanding and meaning in the face of these events are resilient, and maintain their belief system, showing no PTG.

 

In an attempt to rebuild the core belief system, people find themselves engaged in intrusive rumination and attempts to mitigate the emotional distress caused by the events and the inability to grasp them. Finding ways to manage emotional distress is important as a prerequisite to a more constructive form of thinking about their experiences. As people disclose to others and analyze their experiences, they open themselves to schema change through a more reflective, deliberate rumination process. This type of rumination ultimately yields a reconceptualization of the events themselves as well as the underlying core belief system. The revised core belief system may incorporate concepts offered by supportive others, and socio-cultural based  understandings and meanings of trauma.

 

A revised core belief system includes some or all of the five domains of PTG. These domains allow people experiencing trauma to perceive that their distress was a price that was paid for positive changes that are highly personal, perceived as deeply understood, and not merely intellectualizations. However, in most cases, the distress remains a factor in the story of the experience. Another way to think about the PTG that emerges from trauma is in narrative and existential change, or wisdom. Wisdom is related to processing life challenges in an exploratory fashion that focuses on meaning and growth (Weststrate & Gluck, 2017). Reconstruction of the life narrative provides more than a new understanding of events, but produces meaning and purpose that guides future choices and life paths (Neimeyer, 2006).

 

Using quantitative measures, the importance of core belief challenge, event-related rumination, and self-disclosure in the process sequence of PTG has been supported. Core belief challenge and deliberate event-related rumination have been found to have a strong relationship with PTG (Triplett, Tedeschi, Cann, Calhoun, & Reeve, 2012; Morris & Shakespeare-Finch, 2011). Social support and disclosure have also been shown to be related to PTG (Dong, Gong, Jiang, Deng, & Liu, 2015; Sattler, Boyd, & Kirsch, 2014). These major variables, core belief challenge, rumination, and social support/disclosure all appear to have substantial empirical support for their role in the PTG process. In addition, centrality of events is also implicated in the PTG process (Brooks, Graham-Kevan, Lowe & Robinson, 2017). This is because events that have a direct bearing on people’s sense of identity and the course of their lives are likely to be more relevant to the core belief system and therefore, PTG.

 

The process of PTG occurs over a period of time after traumatic events, and researchers have begun to assess the stability or change in PTG in longitudinal studies. It appears that specific levels of PTG are fairly stable over time, while a small percentage of people post-trauma show increases or decreases in PTG over time. For example, Danhauer and colleagues (2013, 2015) studied cancer patients and found six trajectories that indicated stable or increasing levels of PTG over two years. Tsai and colleagues (2016) reported on a large sample of military veterans over two years, and found five groups of PTG trajectories with stable, increasing and declining PTG scores. The majority of veterans reporting moderate or higher PTG were stable in their scores over two years.

 

Posttraumatic growth is usually experienced without the help of psychologists or other mental health professionals. Just as the symptoms of PTSD are naturally occurring reactions to the dire threats of trauma, and often diminish without the help of psychiatric professionals, posttraumatic growth is a naturally occurring process of healing and growth in the aftermath of trauma. Both are natural responses of the mind and body to the injury of trauma. Informal support from people who listen well, wish to learn about a trauma survivor’s experience and see the possibilities for growth can help people see a path toward posttraumatic growth.

 

References

 

Brooks, M., Graham, K. N., Lowe, M., & Robinson, S. (2017). Rumination, event centrality, and perceived control as predictors of post?traumatic growth and distress: The Cognitive Growth and Stress model. British Journal of Clinical Psychology, 56(3), 286–302. https://doi.org/10.1111/bjc.12138

 

Brunet, J., McDonough, M. H., Hadd, V.,Crocker, P. R. E., & Sabiston, C. M. (2010). The Posttraumatic Growth Inventory: An examination of the factor structure and invariance among breast cancer survivors. Psycho-Oncology, 19(8), 830–838. https://doi.org/10.1002/pon.1640

 

Danhauer, S. C., Russell, G. B., Tedeschi, R. G., Jesse, M. T., Vishnevsky, T., Daley, K., Carroll, S., Triplett, K. N., Calhoun, L. G., Cann, A., & Powell, B. L. (2013). A longitudinal investigation of posttraumatic growth in adult patients undergoing treatment for acute leukemia. Journal of Clinical Psychology in Medical Settings, 20(1), 13–24. https://doi.org/10.1007/s10880-012-9304-5

 

Danhauer, S. C., Russell, G., Case, L. D., Sohl, S. J., Tedeschi, R. G., Addington, E. L., Triplett, K., Van Zee, K. J., Naftalis, E. Z., Levine, B., & Avis, N. E. (2015). Trajectories of posttraumatic growth and associated characteristics in women with breast cancer. Annals of Behavioral Medicine, 49(5), 650–659. https://doi.org/10.1007/s12160-015-9696-1

 

Dong, C., Gong, S., Jiang, L., Deng, G., & Liu, X. (2015). Posttraumatic growth within the first three months after accidental injury in China: The role of self-disclosure, cognitive processing, and psychosocial resources. Psychology, Health & Medicine, 20(2), 154–164. https://doi.org/10.1080/13548506.2014.913795

 

Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. Free Press.

 

Lee, J. A., Luxton, D. D., Reger, G. M., & Gahm, G. A. (2010). Confirmatory factor analysis of the Posttraumatic Growth Inventory with a sample of soldiers previously deployed in support of the Iraq and Afghanistan Wars. Journal of Clinical Psychology, 66(7), 813–819. https://doi.org/10.1002/jclp.20692

 

Linley, P. A., Andrews, L., & Joseph, S.(2007). Confirmatory factor analysis of the Posttraumatic Growth Inventory. Journal of Loss and Trauma, 12(4), 321–332. https://doi.org/10.1080/15325020601162823

 

Morris, B. A., & Shakespeare, F. J. (2011). Rumination, post-traumatic growth, and distress: Structural equation modelling with cancer survivors. Psycho-Oncology, 20(11), 1176–1183. https://doi.org/10.1002/pon.1827

 

Neimeyer, R. A. (2006). Re-Storying Loss: Fostering Growth in the Posttraumatic Narrative. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research & practice. (pp. 68–80). Lawrence Erlbaum Associates Publishers.

 

Sattler, D. N., Boyd, B., & Kirsch, J. (2014).Trauma?exposed firefighters: Relationships among posttraumatic growth, posttraumatic stress, resource availability, coping and critical incident stress debriefing experience. Stress and Health: Journal of the International Society for the Investigation of Stress, 30(5), 356–365. https://doi.org/10.1002/smi.2608

 

Schultz, J. M., Tallman, B. A., & Altmaier, E. M. (2010). Pathways to posttraumatic growth: The contributions of forgiveness and importance of religion and spirituality. Psychology of Religion and Spirituality, 2(2), 104–114. https://doi.org/10.1037/a0018454

 

Taku, K., Cann, A., Calhoun, L. G., & Tedeschi, R. G. (2008). The factor structure of the Posttraumatic Growth Inventory: A comparison of five models using confirmatory factor analysis. Journal of Traumatic Stress, 21(2), 158–164. https://doi.org/10.1002/jts.20305

 

Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455–472. https://doi.org/10.1002/jts.2490090305

 

Tedeschi, R. G., Cann, A., Taku, K., Senol, D. E., & Calhoun, L. G. (2017). The posttraumatic growth inventory: A revision integrating existential and spiritual change. Journal of Traumatic Stress, 30(1), 11–18. https://doi.org/10.1002/jts.22155

 

Tedeschi, R. G., Shakespeare-Finch, J.,Taku, K., & Calhoun, L.G. (2018). Posttraumatic growth: Theory, research, and applications. New York: Routledge.

 

Triplett, K. N., Tedeschi, R. G., Cann, A., Calhoun, L. G., & Reeve, C. L. (2012). Posttraumatic growth, meaning in life, and life satisfaction in response to trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 4(4), 400–410. https://doi.org/10.1037/a0024204

 

Tsai, J., Sippel, L. M., Mota, N., Southwick, S. M., & Pietrzak, R. H. (2016). Longitudinal course of posttraumatic growth among US military veterans: Results from the National Health and Resilience in Veterans Study. Depression and Anxiety, 33(1), 9–18. https://doi.org/10.1002/da.22371

 

Weststrate, N. M., & Glück, J. (2017). Hard-earned wisdom: Exploratory processing of difficult life experience is positively associated with wisdom. Developmental Psychology, 53(4), 800–814. https://doi.org/10.1037/dev0000286

 

Author note

Special thanks to Bret Moore and Richard Tedeschi for their support in the development of this manuscript.

To learn more about PTG see the PTG resources center webpage

Commentary

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autores

Judah Viola

Judah Viola, is a Community Psychologist and Professor of Psychology at National Louis University (NLU) in Chicago, Illinois where he teaches in NLU’s PhD program in Community psychology and previously served as Dean of the College of Professional Studies and Advancement. Judah currently serves as the publications committee chair for the Society for Community Research and Action. He is a member of the scientific advisory panel for Boulder Crest Institute for Post Traumatic Growth. He also manages an independent consulting practice specializing in program evaluation, needs assessment, community building, and collaborative community research. His community research and advocacy interests involve neighborhood revitalization, disability rights, affordable housing, access to healthcare and healthy food, community police relations, Posttraumatic Growth and violence prevention and intervention. Some recent publications include: Case Studies in Community Psychology Practice: A Global Lens. Rebus Community Pressbooks, Community Psychologists: Who We Are. In Jason & Glantsman, O’Brien, & Ramian (Eds.) Introduction to Community Psychology: Becoming an agent of change. Rebus Pressbooks, Foundations for Relational Ethics: Introducing a Continuum of Community Psychology Praxis. Global Journal of Community Psychology Practice. 13(3). and Diverse Careers in Community Psychology. Oxford University Press.

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