post traumatic growth
moving forward after trauma
Dr Keron Fletcher
post traumatic growth - index
• psychological concept
• predictors of growth
• post trauma possibilities
• problems with psychological concept
• growth after trauma
• spirituality
• what grows?
• summary
• characteristics of ‘growers’
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Q1: do you believe in post traumatic growth?
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post traumatic growth – common concept
no gain without pain
what doesn’t kill you makes you stronger
it’s all for the best
you learn from your mistakes
per ardua ad astra
Suffering can be a positively transforming experience
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post-traumatic growth - psychological concept
positive psychology movement, 1990s
trauma can produce a meaningful shift in the way one relates to the world, one's
place in it, and to oneself
better able to cope with future adversity
“a positive change experienced as a result of the struggle with a major life crisis or
a traumatic event”
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post trauma possibilities
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succumb
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recover/adapt
resilient
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growth
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trauma
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appealing psychological concept
normally focus on damage – bottle half empty
reports of "growth" after traumatic experiences far outweigh reports of psychiatric
illness
looks for positives of v bad situations - disease, war, bereavement, abuse, natural
disasters
hopeful - good coming from suffering
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Q2. what benefits can “trauma” bring?
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growth after trauma
closer, warmer relationships
greater patience
improved perspective on life
stronger friendships
more emotional involvement
improved understanding of other cultures
conscious involvement
increased insight
cherished freedom
increased assertiveness
stronger religious faith
enhanced self-esteem/understanding
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what grows?
• intellectual growth - improved understanding of other cultures; increased insight; new
possibilities and opportunities have emerged from the struggle (chance for a fresh start, to
take a new direction)
• emotional growth - greater appreciation for life in general; more conscious emotional
involvement;
• social growth – closer, warmer relationships; increased sense of connection to others who
suffer
• personality growth - greater patience; increased assertiveness; enhanced selfesteem/understanding; an increased sense of one’s own strength – “if I lived through that, I
can face anything”.
• spiritual growth - improved perspective on life; stronger, deeper religious faith; change in
belief system
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characteristics of 'growers'
openness to experience, extraversion
optimism (perhaps)
ability to grieve/suffer
support
adaptive coping strategies
confidence (previous successful experiences of coping)
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Q3. what are the predictors of post traumatic growth?
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predictors of growth
spirituality
• very strong positive correlation (O'Rourke, 2008)
• “making sense” is related to positive outcomes of trauma (Pennebaker, 1990).
pre-trauma social support
?? opportunity for emotional disclosure (unproven)
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Q4. what is ‘trauma’?
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problems with PTG as a psychological concept
‘trauma’ is undefined
• challenge, stress, distress, adversity, grief, “highly negative set of circumstances”,
trauma
e.g. “they (Helgeson, Reynolds & Tomich, 2006) discuss the positive life changes
that individuals report making following a traumatic event, for example changing
career to pursue more meaningful work”
cp stressing a bone or muscle vs breaking a bone or tearing a muscle
• “criterion creep” - downgrading of post traumatic stress disorder
e.g. post-traumatic relationship syndrome, post-dental care anxiety, posttraumatic embitterment syndrome
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problems with PTG as a psychological concept
not everyone will grow – not as optimistic as might be thought
not sure if PTG is a process or an outcome
what is the end result of ‘growth’?
• wellbeing is not directly related to growth – some people feel worse despite
reporting growth
• wellbeing is often positively related to physical health outcomes (e.g sufferers
of heart attacks or cancer) or the outcome of a stressful situation
• the stresses associated with the PTG can have negative consequences for
wellbeing
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problems with PTG as a psychological concept
contradictory thinking
• the more stressful situations you have to go through the more opportunity
there should be to grow
BUT
• total amount of stress experienced is related to poor mental health outcomes
what is the evidence that PTG leads to improvements in functioning?
• grief remains painful
• the challenges to ‘recover’ from a major trauma can be far more demanding
than the challenges to ‘grow’ from a minor trauma
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problems with PTG as a psychological concept
are reported outcomes really positive?
• e.g “more assertive” vs more confrontational
• e.g. “new possibilities and opportunities” vs more impulsive
• e.g. “closer, warmer relationships” vs more dependent
does PGT simply mean you benefit from experiences you can manage, but not from
experiences you can’t manage i.e. ‘stress’ leads to PGT but ‘trauma’ does not?
is PGT really “growth” or simply a reaction?
• e.g. reported benefits of surviving major surgery for life threatening illness
wear off after a couple of years
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problems with PTG as a psychological concept
• concept is too broad
• “growth” not clearly defined - ? process, ? outcome, ?what outcome
• “trauma” not clearly defined - job change vs war or natural disaster
• so many variables that they cannot all be controlled for
• not as hopeful as perhaps thought to be
• BUT:
• positives do occur after trauma
• spirituality/sense-making is consistently found to be important in people who
overcome major disasters
• social support is important
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Q5. what is spirituality?
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spirituality
powerful narrative framework which makes sense of life, and attributes ‘meaning’,
‘purpose’ and ‘value’
spirituality makes sense of events or processes that cannot be understood
intellectually or emotionally
spirituality involves ‘faith’ – i.e. a believing response to a teaching (usually
‘religious’ and regarded as ‘truth’)
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mechanistic perspective (non-spiritual)
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origin of universe – big bang
origin of life – chance events over aeons of time
nature of man – advanced animal at top of evolutionary tree
death – failure of evolutionary processes to sustain life indefinitely, end of life
nature of ‘good’? – that which promotes survival advantage
purpose of suffering – provides an aversive experience
meaning of suffering – confers a survival advantage
value of suffering – promotes species survival
value of a disabled person – less than that of an able person
meaning, value and purpose of life – none
highest personal qualities – superior ‘fitness’, superior reproductive capacity
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mechanistic perspective (non-spiritual)
Nepali earthquake survivor – serious head injury, physically disabled, lost loved ones;
veteran returned from Afghanistan with no legs or genitals following stepping on a
landmine
Individual
• of less value – can’t survive without support, can’t reproduce
• possibility of improved functioning – nil
• value of event – negative, disadvantageous, threatens survival
• meaning of the event – none
• purpose of event – none
Society
• individual is a burden (uses up society’s time and resources, can’t contribute, can’t
reproduce)
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spiritual perspective (e.g. Judeo-Christian)
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origin of universe – created by an infinite, eternal, personal, loving God
origin of life – given by God to all living creatures. God is the source of life
nature of man – a being created in God’s image, different from other creatures
death – penalty imposed on mankind for rebellion and rejection of God
nature of ‘good’– that which pleases God and is reflected in ‘laws’ and ‘commands’
purpose of suffering – an essential process for the development of God-like characteristics in
an individual - also the process by which God brings ‘salvation’ and ‘new life’ i.e. God also
suffers
meaning of suffering – God working out purposes which are “too wonderful”
value of suffering – leads to ‘glory’
value of a disabled person – very great, made in God’s image, loved by God
purpose of life – to know and enjoy God now and in eternity
highest personal qualities – love, joy, peace, patience, kindness, goodness, faithfulness,
gentleness, self-control
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spiritual perspective (e.g. Judeo-Christian)
Nepali earthquake survivor – serious head injury, physically disabled, lost loved ones;
veteran returned from Afghanistan with no legs or genitals following stepping on a
landmine
Individual
• accepting of God’s will, assured that God’s purposes are good
• possibility of improved functioning – scope for development of God-like qualities
• value of event – in God’s hands “all things work together for good”
• meaning of the event – opportunity to persevere, and become more spiritually
mature
• purpose of event – God is working his glorious purposes out
Society
• individual is of great worth, and provides an opportunity to show the love of God by
helping those in need
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spiritual perspective - considerations
military chaplains go to war – important
medical facilities should provide opportunities for spiritual help – ‘faith centres’,
places for prayer, permit religious teachers to visit patients
…but not everyone will believe what they cannot access intellectually
other opportunities for ‘sense-making’ (meaning, purpose, value)
• develop own narrative framework
• writing, art, philosophy, animal care, creative activities
• caring for others, caring for animals
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necessary ingredients for post traumatic growth
coherent narrative to make sense of trauma (not in narrow sense of what
happened or who was responsible, but in broader sense of managing the "why did
this happen to me?“)
goal for growth
• where intellectual, emotional, social, psychological growth are not possible there
is still room for growth of personal qualities
support+++
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