Post-Traumatic Growth: An Introduction

We know that psychological trauma exists and that it can have devastating effects on individuals, families, and communities. Trauma has impacted us since humans existed, and according to the National Center for PTSD at the US Department of Veterans Affairs, it has impacted us in a similar fashion across time. When first introduced in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM III), trauma was defined as a catastrophic stressor that was outside the range of usual human experience. Those exposed to such events who developed specific symptoms meet the diagnostic criteria for Post Traumatic Stress Disorder (PTSD).

Growth after Trauma

More recently the concept of recovery from PTSD has included not merely a return to baseline, but the ability to thrive, even at a level higher than before the trauma. Often referred to as Post-Traumatic Growth (PTG), the idea is that as we recovery from trauma, we integrate a deeper understanding of the self with new psychological tools and come out the other end more psychologically healthy than before the trauma took place. Rather than a 'return to baseline,' it involves the development of a higher, healthier baseline. This concept was developed by psychologists Richard Tedeschi, PhD and Lawrence Calhoun, PhD in the 1990s, but it has gotten a lot of attention more recently.

In an article by Collier (2016) of the American Psychological Association, the author points out that PTG is different from resilience. Resilience refers to the ability to bounce back after trauma and may add to one's ability to avoid or minimize the impact of trauma well. According to the author, while PTG, on the other hand, is about growth after trauma. It may be that resilience helps us defend against trauma and PTG occurs when we recover and grow after the impact of trauma. In this sense, they may be different, but they are certainly related.

Tedeschi and Calhoun (1996) developed the Posttraumatic Growth Inventory, used by psychologists today to better understand the level and impact of growth after treatment for trauma related issues. It includes six domains:

1. Appreciation of Life
2. Relationships with Others
3. New Possibilities in Life
4. Personal Strength
5. Spiritual Change

Is PTG Biological or Can it Be Learned?

A study in 2014 by Dunn et al (2014) found a relationship between the presence of a specific gene and psychological growth after Hurricane Katrina. While this advances our knowledge somewhat, we still don't know how the two interact or if they interact at all since correlations show relationships not causation. The authors also point out that along with potential genetic markers, PTG remains a psychological phenomenon. They argue that personality traits like optimism and future orientation play an important role in psychological growth after trauma.

This is good news because we are learning a lot more about optimism and its role in mental health. In previous articles at AllPsych, we found that optimism predicts healthy aging and that it correlates with life satisfaction among those with serious mental illness. We also know that optimism can be learned and that even unrealistic optimism has advantages. The key is seeing situations as temporary, limited, common, and controllable. In other words, when we see traumatic events as having an end, as limited in scope, as common across all people, and as having some level of control, we are able to recover more quickly and reduce the overall negative impact of the trauma.

Research on Post Traumatic Growth

A lot of research has been done on this topic, especially since the onset of the COVID-19 Pandemic. Much of it focuses on healthcare and the frontline workers, including teachers, nurses, doctors, and other essential workers. A study by Chen et al (2020) in the International Journal of Mental Health Nursing looked at trauma, burnout, and post traumatic growth among nurses and found that 13% reported trauma associated with heir work and that 40% experienced growth as they worked through the trauma. Interestingly, they found that women, those who work in COVID-19 specific hospitals or units used resources better and experienced greater psychological growth.

Similarly, a study of psychotherapists and counselors by Aafjes-van Doorn (2022) in the peer-reviewed journal Psychological Trauma: Theory, Research, Practice, and Policy found that therapists can experience post traumatic growth but only when coupled with other factors. For instance, therapists who embraced the changes associated with COVID, such as telehealth, tended to experience more growth. Those with similar degrees of trauma but resistance to changes experienced far less and in some cases zero growth. The key in this study for experiencing growth after trauma seems to be the acceptance of the traumatic situation and its current impact.

In Sum

Trauma is real and it can have long-term devastating effects on those who experience it and even those in their immediate circle. But healing from trauma can lead not only to a return to baseline, but also psychological growth. The light at the end of the tunnel may be even brighter than before. The key seems to be acceptance of your current situation, seeing it as temporary, and recognizing how and when you can insert some control.

References

Aafjes-van Doorn, K., Békés, V., Luo, X., Prout, T. A., & Hoffman, L. (2022). Therapists’ resilience and posttraumatic growth during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 14(S1), S165–S173. https://doi.org/10.1037/tra0001097

Chen, R. (2020). A large scale survey on trauma, burnout, and posttraumatic growth among nurses during the COVID-19 Pandemic. International Journal of Mental Health Nursing, 30(1), 102-116. https://doi.org/10.1111/inm.12796

Collier, L. (2016). Growth after trauma: Why are some people more resilience than others-and can it be taught? Monitor on Psychology, 47(10), 48. Retrieved from https://www.apa.org/monitor/2016/11/growth-trauma.

Dunn, E. C. et al. (2014). Interaction between genetic variants and exposure to Hurricane Katrina on post-traumatic stress and post-traumatic growth: A prospective analysis of low income adults. Journal of Affective Disorders, (152-154), 243-249. https://doi.org/10.1016/j.jad.2013.09.018

Tedeschi, R. G. & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Trauma Stress, 9(3), 455-471. DOI: 10.1007/BF02103658