Post Traumatic Growth

We are only six months into this forsaken year (2020). A car in front of me sported a bumper sticker begging, “Let It End Already!” Our worlds have been disrupted. We endured months of isolation, assaulted by the COVID-19 epidemic. Just as recovery appeared on the horizon, the disturbing video of George Floyd’s death provoked nation-wide protests, riots, and hate. If this was not enough, adding to the instability, the economy teeters at the beginning of another worldwide recession. Our politicians, elected to govern and protect, are too bothered by bipartisan charades to reassure their constituents. While the world is stunned, our personal tragedies don’t wait, compounding the morass of intolerable anxiety. We must survive, gather the pieces of a broken life and find a way for post traumatic growth.

We are driven to ponder the new masked reality. With security shattered and hopes dashed, we must move forward—but how? Can we resiliently gather the shards of broken dreams and march with greater wisdom, strength, and determination? Resilient people emerge from intense struggles with a new sense of power. They grow in the aftermath of trauma.

Post Traumatic Growth and Research

Over the last two and half decades an extensive body of scientific research has amassed examining post-traumatic growth (PTG). Lawrence Calhoun and Rischard Tedeschi led this research movement with a series of provocative articles in the mid-90’s (1995, 1996, and 1998). They cemented their legacy with a seminal publishing in 2004 (Post-traumatic Growth: Conceptual foundations and empirical evidence). While Calhoun and Tedeschi gave the academic boost to post-traumatic growth, the concept isn’t new—trial and growth has been a part of religious and philosophical teachings for centuries.

Friedrich Nietzsche (1888) famously wrote, “What doesn’t kill you makes you stronger.”

Perhaps, we survive this year and make it to 2021 a little stronger. While Nietzsche’s words give hope, they may not be entirely correct. Living through struggle isn’t the only requirement for growth. Often struggle invites bitterness, depression, or fear. A nasty life episode alters actions and can negatively impact wellness. Many respond to extreme conditions by adopting dysfunctional strategies to cope, squashing realistic examination. When reactions injure healthy cognitions, growth falters; we risk languishing in unfulfilling lives haunted by ugly pasts.

Post Traumatic Stress Inventory

Calhoun and Tedeschi’s Post traumatic Stress Inventory (PTSI) provided the conceptual framework for the new body of research. Utilizing their inventory, researchers published numerous findings to broaden our understanding, uncovering correlations between traits, behaviors and conditions that invite growth.

Growth expands psychological functioning, providing greater ability to navigate life’s vicissitudes. Brooks et al. (2017) wrote that “survivors typically report greater appreciation of life, greater personal strength, improved interpersonal relationships, a new life philosophy, and spiritual development (p. 287).

“Posttraumatic growth is the individual’s experience of significant positive change arising from the struggle with a major life crisis” (Calhoun, et al. 2004, p. 521). Calhoun and Tedeschi’s research focus on traumatic events significant enough to challenge basic assumptions. While ordinary struggles, hurts and bruises fail to rise to this level (at least they shouldn’t), we still draw some wisdom from this interesting field of research.

Triplett et al. explains that “the greater the felt need to reexamine core beliefs, the higher the likelihood of experienced growth” (2012, p. 400).

Core Beliefs, Basic Assumptions, and Post Traumatic Growth

Ronnie Janoff-Bulman theorizes in her inspirational book Shattered Assumptions that most children learn to rely on three basic assumptions:

The world is benevolent
The world is meaningful
The self is worthy

The events of 2020 have magnitude, certainly enough to disrupt foundational assumptions. Our security is shaken, leaving an unsettling doubt about the benevolence of our world, provoking stinging questions about meaning, and weakening confidence in our ability to navigate the new reality.

We have a complex schema of assumptions, more than Janoff-Bulman’s basic three. We develop a structured lens to disentangle the complexity of a chaotic world. Our assumptions individualize our view, creating a stabilizing foundation to guide predictions and availability of resources. We draw from family, culture, and language a complex schema of the world to narrate a solidifying story about our lives (see A Healing Narrative). Trauma cruelly smashes this ordered existence, shattering stabilizing assumptions, destroying the bonds that hold life together.

Disorganization After Trauma

After a personal trauma, I compared my life to a perfectly set table, adorned with the best china dishes, matching silverware, and crystal glasses. The events that shattered my expectations were like the tablecloth being rudely yanked from the table, sending the ordered settings crashing to the floor. I was left with chaos—hopes and dreams scattered across the floor. My fundamental beliefs collapsed. The pressures of divorce, wayward teenagers, and a lawsuit pulled me under. Life didn’t play out as expected; I struggled to stay psychologically afloat.

Emotions are positive when experience confirms assumptions; uncomfortable when experience and presumptions contradict. When we act, underlying the action is an invisible scaffold of assumptions and predictions. When life plays along, we experience peace and joy. We sense control. However, when life contradicts, we feel pain and fear. Experiences that collide with assumption require reconciliation. Emotions that disrupt “life as usual” intrude on tranquility, and we ruminate.

Brooks et al. argue that increased perception of control over the future enhances psychological functioning (2017, p. 288). I presume, then, that decreased perception of control typically decreases psychological functioning.

Resolving Dissonance Encountered by Trauma

We resolve dissonance between assumptions and experience in a variety of ways. We can simply distract ourselves, coping by ignoring, and eventually forgetting the conflict. Many addictions extinguish disruptions but destroy our lives in other ways. We can assimilate the contradictions into our current beliefs, creating a loophole, allowing for exceptions; or we accommodate by adjusting beliefs to fit the incongruent experience.

Janoff-Bulman explains that assimilation is “a process involving changes in the new, incoming information such that there may be a good fit with preexisting schemas.” She continues, “accommodation, on the other hand, involves changes in these preexisting schemas so as to maximize the fit between the old and new” (2010, p.29).

Posttraumatic growth typically belongs to the latter, accommodating experience by revising beliefs. Accommodation isn’t necessarily the best path. Sometimes we’re best served through assimilation, or even distraction. Accommodation doesn’t always improve schemas. We may adopt dysfunctional assumptions, leading to more decay than growth. A person, for example, that responds to trauma by adopting the radical dogma of a destructive movement isn’t progressing. Different isn’t always better.

Growth Factors and Psychological Wellness

Calhoun and Tedeschi’s model of growth isn’t measured by subjective wellbeing but more substantial psychological wellness. “Psychological well-being includes high-levels of autonomy, environmental mastery, positive relationships with others, open to personal growth, purpose in life, and self-acceptance” (2012, p. 318).

The Post Traumatic Growth Inventory identifies five factors for growth:

Relating to others
New possibilities
Personal strength
Spiritual changes
Appreciation for life (Joseph et al. 2012)

Resilience and post-traumatic growth share some similarities. Post-traumatic growth requires resiliency. Steve Southwick and Dennis Charney wrote in their book on resilience that, “when stress can be managed, it tends to be very good and even necessary for health and growth. Without it, the mind and body weaken. If we can learn to harness stress it can serve as a catalyst for developing greater strength and even greater wisdom” (Southwick & Charney, 2018, location 833).

Coping and Post Traumatic Growth

Coping is a hallmark of resilience, enhancing the livability of our existence. We shouldn’t allow small events to throw our lives into an emotional tizzy. A disagreement with a spouse shouldn’t trigger frightening ruminations about divorce; a correction by a supervisor shouldn’t shake self-esteem; and a relapse doesn’t suggest recovery is impossible. We need healthy coping, sprinkled with Martin Seligman’s positive psychology (2006). We stumble, stand-up, assimilate, and move forward.

Security is essential for wellness. We need continuity of experience. While some accommodation catapults us to greater wisdom, constant shifting of beliefs creates a feeble foundation. We can’t let each challenging event reorder beliefs.

Our conservative cognitive machine fights against changing assumptions. Sometimes cognitive conservatism is good; sometimes it’s bad. Often, the best solution is to cope and move forward in the same direction. But events can’t always be easily assimilated when assumptions are faulty. Reality often clashes with misconstrued fundamental beliefs; no matter how hard we try; the experience fails to resolve and melt into the past. We suffer from the cognitive disruptions—Festinger’s cognitive dissonance (see Cognitive Dissonance). We must accommodate because we can’t un-experience what we experienced.

However, we must be cautious, extensive coping may mitigate disruptions worth closer examination. We soothe some emotions, allowing problematic behaviors to continue—defensive mechanisms. Perhaps our spouse is abusive, and the relationship is incompatible to psychological wellness; our boss may be a deranged narcissist, or our technical work skills are subpar. Ignoring impinging ruminations may be detrimental when the cognitive alarm points to correctable problems.

Window of Opportunity

Research suggests there is a window of opportunity when stress is neither too little nor too much (Joseph et al. 2012, p. 320). With too little stress, experience doesn’t intrude on cognitions with enough force to demand reconciliation; we continue as we always have. If too much, stress destabilizes and we can’t function, the intrusion overwhelms, and accommodation isn’t possible (at least not at that moment). We may, overtime, settle emotions enough to objectively examine the experience and promote growth.

Researchers discovered that higher levels of traumatic exposure are associated to both Post-traumatic stress and post traumatic growth (Triplett et al., 2012, Dekel et al., 2011). Post traumatic growth doesn’t belong to resilient people that magically escape the devastating blows of trauma. Growth arises from the ashes—events that seriously impact wellness.

Southwick & Charney explain, “a resilient person may be deeply affected by a traumatic event, and may experience psychological symptoms such as depression, recurrent intrusive memories, or hypervigilance – but it (resilience) does mean being able to carry on with the important facets of one’s life in spite of painful and distressing symptoms. . .” (2018, location 365).

Rumination and Thought in Post Traumatic Growth

Traumatic events intrude because they are impactful. They invade cognitions with intrusive thoughts. Later, if our adaptive functions work correctly, the thoughts transform from bothersome intrusions constructive plans. Cognitive thought processes create a pathway for post-traumatic growth. However, thoughts don’t always progress; they easily lodge in destructive ruminations, agitating rather than settling. The initial stirring of disturbing rumination is necessary to motivate change; but prolonged brooding fails to move forward, settling in the gloom of tragedy.

Calhoun et al. explains that rumination “refers to several varieties of recurrent [event related] thinking, including making sense, problem solving, reminiscence, and anticipation” (2004, p. 522). We naturally think incessantly about stressful situations, leading to disconnection and loss of sleep. Our minds try to “understand, resolve, and make sense of what happened” (2004 p. 522).

Sometimes thoughts aimlessly bounce, sucked into a negative vortex. We stubbornly cling to our broken world, refusing to accommodate but incapable of assimilating. Our cognitive wheels turn, the motor tires, and we collapse, depressed and despondent, missing growth promoting opportunities to reexamine our presumptive world. When thoughts are not “exclusively negative,” they are predictive of posttraumatic growth. Healthy rumination is “a cognitive struggle to rebuild a presumptive world” (Scrignaro, et al., 2018) to reestablish security and predictability.

Intrusive Thoughts

Intrusive ruminations prime the mind for more deliberate problem solving. This shift is essential for growth. The intrusive ruminations are associated with greater distress, which for some people activates more deliberate ruminations that are associated with PTG (Brooks, et al. 2017, p. 289).

We must carefully examine ruminations to avoid incessant brooding and encourage productive reflection. Our cognitive musings can mold trauma into something that heals or something that beats us into stunned helplessness. It’s not necessarily the event, but the meaning we give to that event that holds power over us. Harold Kushner wrote in his classic book, When Bad Things Happen to Good People:

Let me suggest that the bad things that happen to us in our lives do not have a meaning when they happen to us. They do not happen for any good reason which would cause us to accept them willingly. But we can give them a meaning. We can redeem these tragedies from senselessness by imposing meaning on them. The question we should be asking in not, “Why did this happen to me? What did I do to deserve this?” That is really unanswerable, pointless questions. A better question would be “Now that this has happened to me, what am I going to do about it?” (p. 138).

Finding Meaning in the Trauma

Viktor Frankl based his therapeutic theory (logotherapy) on giving life meaning. In his must read book, Man’s Search for Meaning, he wrote:

In the way in which a man accepts his fate and all the suffering it entails, the way he takes up his cross, gives him ample opportunity. . .to add deeper meaning to his life… And this decides whether he is worthy of his suffering or not (2006, p. 67).

Frankl later explains our response will be the immortal “footprint in the sands of time… for better or for worse. . . the monument of (our) existence” (p. 121).

“He who has a why to live for can bear almost any how.”
~ Friedrich Nietzsche

Within the framework of posttraumatic growth, our “why” is shattered and must be restructured with new meaning. We can grow in a variety of ways, utilizing different foundations. Research has associated post traumatic growth with hope (Umer & Elliot 2019), religion (Seyed Bagheri et al. 2019), spirituality (Khursheed & Shahnawaz, 2020), social resources (Shang et al. 2020), and self-compassion (Chan et al. 2020), only to name a few.

Positive Emotions and Healing

Perhaps, Barbara Frederickson’s broaden and build theory casts some light on a unifying factor that joins with various paths to enable growth. She suggests that shifting away from the exclusive negative, intrusive thoughts to positive deliberate ruminations is essential. The broaden and build theory posits that experiences of positive emotions broadens people’s momentary thought-action repertoires, which builds their physical, intellectual, social, and psychological resources (Frederickson, 2001). Positive emotions foster factors essential for flourishing, necessary for resiliently adapting to life challenges.

There are many ways to elicit positive emotions. Generally, research documents associations between posttraumatic growth and hope, religion, spirituality, social connections, and self-compassion. However, these findings may just be illuminating the avenue used to alleviate negative thoughts, allowing the mind to draw upon growth oriented mindsets.

Fredrickson explains that, “positive emotions are worth cultivating, not just as end stages in themselves but also as a means to achieve psychological growth and improved well-being overtime” (2001). Basically, both positive and negative effect have adaptive survival qualities. Most basic psychology courses explain the importance of negative affect. Significantly, fear, anger and other negative affect emotions narrow attention on immediate threats. Accordingly. attention zeros in on the moment, exciting biological systems to fight or flee. Positive affect, however, broadens attention. When affect signals security, we approach, continue and explore.

Positive emotions, typically, are not adaptive to life-threatening situations. However, they broaden our ability to integrate once a threat has subsided. Fredrickson writes, “In contrast to negative emotions, which carry direct and immediate benefits in situations that threaten survival, the broadening thought-action repertoires triggered by positive emotions are beneficial in other ways. Specifically, these mind broadening mindsets carry indirect and long-term adaptive benefits because broadening builds enduring personal resources, which function as reserves to be drawn on later to manage future threats” (2001).

Emotions are Natural

Both positive and negative emotions are natural. Ann Masten wrote that, “resilience appears to be a common phenomenon that results in most cases from the operation of basic human adaptational systems. If those systems are protected and in good working order, development is robust even in the face of severe adversity” (2001).

We invite positive emotions with realistic optimism. Occasionally, we must, at some point, escape the dread that life will always be overshadowed by the trauma. However, realistic optimists nurture positive expectations that promote active striving. This is an upward spiral. The realistic optimist doesn’t exclusively focus on Pollyanna escapisms; but effectively integrates relevant negative information with positive expectations of recovery.

Depression and Anxiety

Depression, on the other hand, is an example of negative emotions helplessly slipping into a downward spiral. The negative affect amplifies feelings of inescapability, which then inhibits goal directed action. Often medication and therapeutic professionals must be called upon to stop the avalanche of depression and anxiety, creating space for the broadening and building states of mind.

During my post-trauma depression, I began a practice of meditation. After a period of time, I experienced a fleeting feeling of peace—just a brief glimpse into the possibility of recovery. Eventually, this passing moment slowly expanded in hopeful optimism and effortful behavior. The small emotion blossomed into a full experience of newness. The meditation was a new avenue of coping for me and it worked.

Healthy coping assists moving disastrous emotions from problematic intrusions to deliberate striving. Southwick and Charney list three coping mechanisms that broaden attention: positive reappraisal, problem-focused coping, and infusion of meaning (2018). Joseph et al. adds acceptance and seeking social support (2012) to the list of useful coping strategies. I found that meditation serves as a momentary comfort, creating space, giving an opportunity for more growth oriented coping practices.

Growth is a Normal Human Function

The magic of growth is less miraculous than we think. Post traumatic growth is a product of a well-working adaptive system. We have access to healthy coping practices that can soothe intrusive emotions and create room for a broadening exploration of hurt. These explorations integrate the hurt into a new healing narrative of self. We can utilize mindfulness, hope, self-compassion, spirituality, or religion as mediums for growth. However, success is only achieved when we first create the emotional space to explore, learn and integrate.

2020 still hurts; but for the resilient, this year marks the beginning of change, inviting powerful, life developing growth. However, the changes shouldn’t be confined to the individuals but with an army of changed people, the posttraumatic growth may expand to the nation and world, making this year, in an odd way, the best year ever.

Psychology Fanatic New Article Updates

References:

Bauer, J., & McAdams, D. (2004). Growth Goals, Maturity, and Well-Being. Developmental Psychology, 40(1), 114-127.
Brooks, M., Graham‐Kevan, 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. DOI: 10.1111/bjc.12138
Calhoun, L., Cann, A., Tedeschi, R., & McMillan, J. (2004). A Correlational Test of the Relationship Between Posttraumatic Growth, Religion, and Cognitive Processing. Journal of Traumatic Stress, 13(3), 521-527.

Chan, B., Deng, J., Li, Y., Li, T., Shen, Y., Wang, Y., & Yi, L. (2020). The Role of Self-Compassion in the Relationship between Post-Traumatic Growth and Psychological Distress in Caregivers of Children with Autism. Journal of Child and Family Studies, 29(6), 1692-1700.
Dekel, S., Mandl, C., & Solomon, Z. (2011). Shared and unique predictors of post‐traumatic growth and distress. Journal of Clinical Psychology, 67(3), 241-252.

Suggested Reaading:

Seligman, M. (2006) Learned Optimism: How to Change Your Mind and Your Life. Vintage; Reprint edition.

Seyed Bagheri, S., Dehghan, M., & Khoshab, H. (2019). Post-traumatic Stress Disorder and Post-traumatic Growth Among Muslim CPR Survivors. Journal of Religion and Health, OnlineFirst, 1-11.

Shang, F., Kaniasty, K., Cowlishaw, S., Wade, D., Ma, H., & Forbes, D. (2020). The Impact of Received Social Support on Posttraumatic Growth After Disaster: The Importance of Both Support Quantity and Quality. Psychological Trauma: Theory, Research, Practice, and Policy, OnlineFirst, 1
Southwick, S., Charney, D. (2018) Resilience: The Science of Mastering Life’s Greatest Challenges. Cambridge University Press; 2 edition.

Tedeschi, R.G. & Calhoun, L. G. (1995) Trauma and Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, CA: Sage Publications
Tedeschi, R.G. & Calhoun, L. G. (1996) The Posttraumatic growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress. 9/ 455-471
Tedeschi, R.G. & Calhoun, L. G. (1998) Personality and transformation in the face of adversity
Tedeschi, R.G. & Calhoun, L. G. (2004) Post-traumatic Growth: Conceptual foundations and empirical evidence. Psychological Inquiry. 15, 1-18
Triplett, K., Tedeschi, R., Cann, A., Calhoun, L., & Reeve, C. (2012). Posttraumatic Growth, Meaning in Life, and Life Satisfaction in Response to Trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 4(4), 400-410.
Umer, .M., & Elliot, D.L. (2019). Being Hopeful: Exploring the Dynamics of Post-traumatic Growth and Hope in Refugees. Journal of Refugee Studies, AdvanceArticle.