Posttraumatic Growth: Theory, Research, and Applications

It didn’t start with the name “posttraumatic growth” (PTG).  It started at the dawn of man, when countless of our ancestors faced challenges, setbacks, and tragedies and then grew from them.  Posttraumatic Growth: Theory, Research, and Applications may be the latest codification of the concept that Tedeschi and Calhoun labeled “posttraumatic growth,” but that doesn’t mean that it didn’t exist before.  Nearly three decades after their original work, this work reports on the concept as well as the misconceptions that have attached themselves to PTG since the original publications.  This isn’t my first foray into reading Tedeschi’s work.  I’ve previously read and reviewed Transformed by Trauma, which shares stories of those who have experienced growth.

PTG Summary

To provide some context, posttraumatic growth is “positive psychological changes experienced as a result of the struggle with traumatic or highly challenging life circumstances.”  It is a framework consisting of five domains:

• Appreciation of life
• Personal strength
• New opportunities
• Relating with others
• Spiritual change

For the most part, PTG is about the internal experience of the person rather than the externally observable, tangible results.  This is important because as is often addressed in therapies and groups, the circumstances surrounding the struggle may not change – but the response to it can.

Heroes Journey

Joseph Campbell spent a lifetime researching myths.  From his research, he discovered patterns that emerged in all epic myths across countless cultures.  That pattern he called the hero’s journey.  When Bill Moyers sat down with Joseph Campbell for a PBS series, the extended cut of their conversation ended up in the book The Power of Myth.  It highlights some of the interesting parallels between cultures and how heroes change over the course of their stories.

The key is that heroes face adversity and challenge.  They face loss and trauma.  Then, they grow.  The hero rises to the occasion and moves their personal mission forward.  They find focus and ultimately save their groups.  This indicates that, for centuries in cultures across the world, we’ve seen PTG as the best thing.  It’s the way that heroes behave, and don’t you want to behave like your favorite hero?

Posttraumatic growth doesn’t draw out this parallel in its pages, but it’s one that I couldn’t avoid as I evaluated how PTG has been a part of humanity through the ages.

Relationship to Resilience

Much has been made of the concept of resilience in modern media.  However, so much has been made of it that it has lost its meaning.  People have lost touch with the fact that resilience returns something to its original state after a challenge or stress.  While this initially seems desirable, it’s not long before you realize that the better response would be for things to become better.  Antifragile lays out the framework and conditions for how stress and challenge can make things better.  We have examples in our everyday worlds, like those who exercise literally break down their muscle tissue only for the body to rebuild it stronger than the last time.

Wouldn’t a better response to stress, trauma, and tragedy for us to find ways to be better because of it?  Of course, that is the goal, but how do you tell the mother or father who has just lost their child that they’ll be better off for it?  In deep loss and grief, it’s impossible to see that growth is even an option.

The difference is that, for PTG, the goal is greater than where things started.  Instead of returning to normal, we’re looking for a new, better normal.

PTG and PTSD

It’s a natural, but overly simplified, perspective to see posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) on opposite ends of the spectrum, but to do so prevents the reality that PTG and PTSD can coexist at the same time.  (See Traumatic Stress for more on PTSD.)  It seems counter-intuitive that you’re experiencing growth at the same time as being imprisoned by recurrent memories that refuse to be integrated into our core narrative, but one doesn’t preclude the other.  We can adjust our basic assumptions about the world and thereby achieve growth while simultaneously being unable to fully integrate the memories into our internal autobiography.

In short, they are associated with two different aspects of the trauma experience.  PTSD is associated with the recall of the event, and PTG is associated with the resulting need to adjust beliefs.  People can, and sometimes do, accomplish one without the other.

Fundamental Beliefs and Basic Assumptions

In Trauma and Recovery and Traumatic Stress, I used the language “fundamental beliefs” to refer to the basic set of assumptions that we have about the world and the way that it works.  These terms are – in effect—the same thing, and under both is the assumption that they’re hidden.  In both cases, the implication is that the thing at the heart of trauma is the way that we see the world.  It’s more than the loss and the threat.  It’s the fact that it changes the way we see the world.

This reorganization is not without its challenges, but it also creates opportunities that didn’t exist with the previous view of the world.  Does the reconstituted set of basic assumptions and beliefs create or allow for a new appreciation of life, new opportunities, better relationships, or a spiritual awakening?  In some cases, it seems that the answer is yes.

The Weakness of Thriving

As a term for PTG, “thriving” has some issues.  It means to prosper or flourish – but how do we measure that in human terms?  Happiness might be one answer, but happiness is notoriously hard to measure and predict.  Some, like Barbara Ehrenreich in Bright-sided, criticize the push towards happiness, while Barbara Fredrickson in Positivity argues that being positive has its own rewards.  Desmond Tutu and the Dalai Lama agree in The Book of Joy.  Sonja Lyubomirsky focuses on The How of Happiness.  Conversely, Daniel Gilbert in Stumbling on Happiness cautions that we’re bad at predicting what will make us happy.

Part of the challenge is separating persistent happiness – or joy – compared to moment-to-moment happiness.  Mihaly Csikszentmihalyi’s concept of flow points out that people are generally happier if they’ve had more time in flow.  (He documents flow in Flow and Finding Flow.)  Some would call it “persistent joy,” as Mattheu Ricard explains in his book, Happiness.

In short, we have a problem defining happiness in any meaningful way, and therefore we can’t use happiness as a measurement for thriving.  Sometimes people fall back on external, materialistic measures, but these fall well short of the inner experience that people who experience PTG have.

Pain as Necessary

There are stories embedded into both Buddhism and Judeo-Christian tradition about the necessity of struggle.  We’re reminded of the struggles of Job.  We’re encouraged to find mustard seeds from people who’ve not known death and pain.  We’re reminded that pain isn’t optional.  Judeo-Christian beliefs are that we live in a fallen world.  The painless world that was created in Eden isn’t available to us.  Buddhists believe in both the impermanence of life and in that life is suffering.

More practically, we know that helping chicks during the hatching process – bypassing the struggle to escape the shell – may be a death sentence.  They need the hatching process and the struggle it entails to transition.  Sea turtles that are helped to the sea after birth are hopelessly disoriented and tend to swim in circles instead of swimming in lines.  (In addition, touching a sea turtle is a federal offense, so don’t do it.)  Across nature as well as religion, struggle is necessary.

In many traditions, it’s struggle by which we achieve wisdom (or enlightenment).  The desire to develop wisdom has challenged philosophers since the beginning of written history.  It has equally been associated with struggle and pain.  Those who have been declared wise men almost universally achieved this title through struggle.

Vulnerability and Strength

People who have been through traumatic experiences and have developed PTG often reveal a strange dichotomy.  On the one hand, their experience taught them that they were vulnerable in ways or to degrees that they didn’t believe – or couldn’t believe.  They also will say that they discovered the strength they had.  They admit to never knowing their own capabilities and only through the struggle did they realize what they’re capable of.

We often say that where we are now is great, but we would have loved to get here without struggle.  We realize that this isn’t realistic, but still, the pain and struggle isn’t fun – even if the results are worth it.

PTG as a Process

Much like trauma, which can refer to an event or the reaction to the event, PTG can refer to the outcomes – the changes.  It can, however, also refer to the process through which people grow.  While outcomes are static and finite, the process of PTG can go on for a lifetime.

In twelve-step groups, participants are encouraged to always see themselves as recovering rather than recovered.  (See Why and How 12-Step Groups Work for more.)  This has a certain fatalistic attitude attached, but only if you don’t allow for the perspective to change.  Experienced participants realize that the struggles and vulnerabilities continue to shrink over time.  Similarly, you can continue to grow from trauma throughout life – but it won’t be the same as today.

The Role of Creativity and Flexibility

Since the outcomes of PTG are obviously better – there’s growth in the name – there’s a desire to understand what influences who will and who will not experience PTG.  How do we find factors that reliably predict who will achieve PTG?  The answer seems like people who are more creative are more likely to experience PTG.  If you don’t feel like you’re creative, I’d encourage you to develop your Creative Confidence.  Everyone is born creative.  We’ve learned to be less creative and to conform to society – but we can buck that trend and be our own person.

More than what we traditionally think of as creativity, it may be that cognitive flexibility holds the key.  The ability to accept that both the pain and torment of the tragedy and the peace from PTG come from one thing is an important dialectical perspective on the event – and in general, this may be what drives us to grow.  It could also be that those with greater cognitive flexibility are those who are more readily able to reevaluate their basic assumptions and change them.  This may explain why some research shows that growth is more likely to occur for those who are younger.  It may be that the degree of fixedness in old age becomes a barrier.

The Role of Disclosure

You’re only as sick as your secrets.  It’s a common phrase for those with substance use disorders – and anyone who finds themselves in a twelve-step program.  We recognize that many of the challenges that we have in life are about where we lie to ourselves and others.  Leadership and Self-Deception particularly challenges the things that we do when we’ve stopped being honest with ourselves.  It speaks of the ways that we interact with others and the kinds of challenges that these patterns cause.

While disclosure is risky – and you’ve got to be judicious about who you share with – ultimately, the more open, honest, and transparent you can be about the trauma, the better off you’ll be in the end.  (See Trust => Vulnerability => Intimacy, Revisited for more on trusting others and the impacts.)

Self-Efficacy and Social Supports

Another big question about PTG is whether it’s more important to have self-efficacy or social support.  The answer is self-efficacy in the long run.  It’s a journey, and like any journey, no one else can do it for you.  The best case scenario is that you have people supporting you and rooting for you, but ultimately, it’s you who has to make the move towards Posttraumatic Growth.