Putting the World Back Together Differently

It’s Memorial Day, a time to think about people who are gone. When I was researching my recent article about grief, I came across a paper by Lawrence Calhoun, Richard Tedeschi, Arnie Cann, and Emily Hanks at the University of North Carolina at Charlotte, in which they explore the possibility of post-traumatic growth following bereavement.
 

The authors are careful to remark that the growth doesn’t come from the loss. How could the loss of someone cherished be a good thing? The growth comes from the struggle with the loss.

Posttraumatic growth (which I will sometimes call just growth for convenience from now on) also doesn’t necessarily mean that suffering is diminished. Growth and suffering appear to be statistically relatively independent. They frequently happen concurrently.

When do people experience posttraumatic growth?

The greater the upset to a person’s assumptive beliefs about the world, the greater the potential for posttraumatic growth. Losing a relative who has had a long full life followed by a debilitating illness doesn’t upset the apple cart nearly as much as losing someone unexpectedly, particularly someone young enough to have a lot of life ahead. Posttraumatic growth is more likely to follow losses that are unexpected and seem unfair. These losses are associated with both more distress and more potential for growth.
 

Thus growth emerges from struggling with a broken picture of the world, putting it back together in new ways. The authors even state, “… it is the level of disruption of core beliefs which best predicts growth.”

What types of posttraumatic growth are there?

Calhoun and colleagues have identified five domains of growth. A given person will experience different degrees of growth in the five domains.

1. Changes in self-perception: Growth often takes the form of both feeling more vulnerable and having a new awareness of strengths, thus feeling more able to face what the future brings.
    
2. Changes in relationships with others: These changes can be both greater closeness with people close by and greater empathy with strangers and others who experience loss.
    


  Cherry blossoms courtesy of DonSutherland1

3. New possibilities: Particularly when a spouse dies, a person finds himself or herself taking on responsibilities that the lost person performed. These can include both tasks that the other performed, and relationships that the other managed.
    
4. Appreciation for life: Renewed awareness that life may end any moment can change the way we feel about our very ordinary days. When my friend Linda died, I was instantly alert to the fact that I might die at any moment, or my husband might die, or my children. We appreciate cherry blossoms in the springtime more intensely because we know they will be gone within days.
    
5. Existential and/or spiritual growth: I was intrigued by the authors’ use of the Celtic concept of thin places: places where the boundaries between this world and other realities are permeable. Perhaps spiritual growth comes from being more open to things that can’t be understood directly.

These are the kinds of growth that can follow any kind of trauma. The ones that are most likely to occur following bereavement are the 2nd (changes in relationships), 4th (appreciation for life), and 5th (spirituality).

Posttraumatic growth: What happens inside?

Strangely enough, the authors identify rumination as an important factor. Rumination is often described as an enemy of well-being. But the authors distinguish between intrusive rumination, which forcefully brings negative thoughts back into the attention of the sufferer, and deliberate rumination, which generally focuses on understanding the challenge and trying out different ways of rebuilding a functioning world view. While most people suffer from intrusive rumination right after an event, people who experience growth tend to move on to deliberative rumination.

Self-disclosure appears to be related to growth, but it’s still a bit unclear what kinds of self-disclosure are most useful. They speculate that self-disclosure related to growth themes might be more effective than reliving the details of the negative event over and over.

Finally, it appears that growth is more likely when people are exposed to the cultural idea that growth is possible. If that is the case, then I hope this article may reach someone who hasn’t otherwise thought about growth as a possible outcome of bereavement.

These ideas are being tested.

To test the relationship of these factors to growth, Cassie Lindstrom, Arnie Cann, Lawrence Calhoun, and Richard Tedeschi conducted a study with college students who had been exposed to a highly stressful event within the last 2 years. They used Cann’s Core Beliefs Inventory to explore how much participants had to reassess their assumptions about the world. They used a rumination scale to determine what kinds of rumination occurred in the two weeks right after the event and in two weeks right before the study. They asked people about self-disclosure, whether they discussed with family and friends either negative aspects of the event or possible positive outcomes. They used 7 questions to explore whether posttraumatic growth themes occurred within their proximate and more distant cultural contexts. Finally, they used a Posttraumatic Growth index to determine the degree of growth.

Results included

• 98% had been exposed to stories of people who had experienced growth from struggling with very difficult events. I found this particularly interesting considering Seligman’s statement in Flourish that more than 90% of the cadets had heard of PTSD, but less than 10% had heard of posttraumatic growth. Perhaps the term is not commonly used, but the idea, at least among American college students, seems to be accessible.
   
• There appears to be a strong correlation between degree of upset to core beliefs and degree of growth. However longitudinal studies are needed to conclude whether the relationship is causal.
   
• There seem to be relationships among different kinds of self-disclosure, different kinds and degrees and times of rumination, and levels of stress. For example, self-disclosure about possible positive aspects is related to deliberative rumination as well as to lessening of stress. The relationships, though, are too complex to fully describe here. They found no clear relationship between self-disclosure and PTG in this study, although that relationship had been found in another study led by K. Taku.

Limitations of the study include a cross-sectional design, so no clear statements can be made about causality or temporal sequence, a population limited to college students in one region of the United States, and new measures for self-disclosure and social context that have not been more generally validated.

Posttraumatic growth is an active area of research.

There appears to be a lot going on in the posttraumatic growth field. For example, I found 10 books related to coping and growth following trauma, a few of which are listed below. As a goal of their review of research on adversarial growth, Alex Linley and Stephen Joseph stated, “There is now a need to establish more clearly the variables that are associated with adversarial growth.” The information in this article comes mostly from the two papers described, both of which reflect the views of Lawrence Calhoun and Richard Tedeschi. I found them interesting ways to view what goes on around us, as death intervenes in life.

 

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References

Calhoun, L. G., Tedeschi, R. G., Cann, A. & Hanks, E. A. (2010). Positive Outcomes Following Bereavement: Paths to Posttraumatic Growth. Psychologica Belgica, 50 (1-2), 125-143(19). Abstract & access

Calhoun, L. G. & Tedeschi, R. G. (Eds.) (2006). The Handbook of Posttraumatic Growth: Research and Practice. Lawrence Erlbaum Associates.

Linley, P. A. & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17(1), 11-21.

Joseph, S. & Linley, P. A. (Eds.) (2008). Trauma, Recovery, and Growth: Positive Psychological Perspectives on Posttraumatic Stress. Wiley.

Lindstrom, C., Cann, A., Calhoun, L. G., & Tedeschi, R. G. (2011). The Relationship of Core Belief Challenge, Rumination, Disclosure, and Sociocultural Elements to Posttraumatic Growth. Psychological Trauma: Theory, Research, Practice, and Policy, Advance online publication. doi: 10.1037/a0022030. Abstract.

Taku, K., Tedeschi, R. G., Cann, A., & Calhoun, L. G. (2009). The culture of disclosure: Effects of perceived reactions to disclosure on posttraumatic growth and distress in Japan. Journal of Social and Clinical Psychology, 28, 1226–1243.

Tedeschi, R. G. & Calhoun, L. G. (1995). Trauma and Transformation: Growing in the Aftermath of Suffering. Sage Publications.

Weiss, T. & Berger, R. (2010). Posttraumatic Growth and Culturally Competent Practice: Lessons Learned from Around the Globe. Wiley.