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Journey from Adversity: #WHATIS Post-traumatic Growth? (Book Review)

by Alicia Assad
written by Alicia Assad

“That which does not kill us makes us stronger.” ~Friedrich Nietzsche

This familiar quotation suggests our struggles will lead to resilience, if we pull through them at all.

Yet if we find ourselves enduring traumatic experiences so powerful that they turn our worlds upside down, we might wonder,

“How? How am I going to get through this and become stronger?”

I have been in this place of struggle, having survived a few serious traumas myself. Since I am relentlessly optimistic, I always believed I would somehow find a way to piece my shattered beliefs together. But I was desperate to know how.

A positive psychology practitioner, I was applying tools like gratitude and hope theory to move away from despair, but it wasn’t until I stumbled across research illuminating the experience of growth after adversity that I began not only to heal, but also to grow.

Then I actively sought a positive life transformation by sharing my experience publicly. I became passionate about disseminating the information I found valuable in a time of struggle.

My personal connection to the topic of post-traumatic growth offered me this opportunity to review Miriam Akhtar’s book, #WHATIS Post-Traumatic Growth?, a book about the journey from trauma to growth.

A trauma survivor, my first thought when I finished reading it was,

“I wish I had had this book when I was suffering.”

What’s in the Book?

In five chapters and 141 compact pages, Akhtar’s personal experience is woven with the research and practical tools of positive psychology to raise awareness about the concept of post-traumatic growth, that is, that positive change can happen in the wake of a traumatic event.

Akhtar gives her readers 20 inspiring reasons to be open to the concept of post-traumatic growth, and her personal anecdotes give her research-based tools authenticity.

What initially struck me about this small book is its structure. Akhtar organizes a vast amount of information in a simple, easily digestible manner, which I believe is crucial for the real world. In the wake of trauma, I felt exhausted, defeated, and disoriented. That was not the time to dive into a big book. However, I could picture myself dipping into Akhtar’s message and finding tools practical enough to apply even in times of high stress.

Shame Begone

Akhtar discusses the unnecessary shame often associated with negative subjective experience. She explains that trauma can shake our beliefs and make us feel that our safety is shattered. That can lead to emotional, psychological, and physical harm, which can seriously disrupt the course of our lives.

We can experience this even in facing smaller repeated traumas. Her broader definition of trauma might inspire readers to look at even more ordinary adversities for opportunities for growth.

Naturally, we want to avoid adversity at all costs, but if we move toward the adversity that life inevitably brings, we might experience a positive transformation in one or more of the five key areas:

  1. Personal strength
  2. Closer relationships
  3. Greater appreciation for life
  4. New possibilities
  5. Spiritual development

This information is inspiring, but it brings me back to the question I once wondered: “How.”

The How of Post-traumatic Growth

Akhtar first reveals,

“The process starts by trying to make sense of the trauma, which can prompt a re-evaluation of our core beliefs… But later on this rumination shifts into something more constructive as people find some meaning in the adversity and gravitate toward a place of acceptance about their changed world, gaining wisdom and well-being along the way.”

Tools

In the pages that follow, she delivers tools based on theory from mindfulness to cognitive behavioral therapy to help manage our emotions. These are followed by techniques to address the physical realm, reminding us to focus on physical activity, rest, and sleep when enduring trauma.

Rounding this off is her Personal Resilience Toolkit, a well-packaged compilation of techniques from ACT to a discussion of mindset and constructive rumination.

Akhtar shows us not only that there is a light at the end of the tunnel, but illuminates a step-by-step path to help us to reach it. Her path is substantiated with personal experience, inspiring stories, and research-based tools.

If you are eager to make sense of life’s inevitable adversities, read this book. Akhtar reminds us that our future can be bright perhaps not in spite of the adversity we face, but because of it.
 

 

References

Akhtar, M. (2017). What is Post-Traumatic Growth?. Watkins Publishing.

Akhtar, M. (2012). Positive Psychology for Overcoming Depression: Self-Help Strategies for Happiness, Inner Strength and Well-Being. London: Watkins.

Assad, A. (2015). Growing through adversity. Positive Psychology News.

Roepke, A. M. & Seligman, M. E. P. (2015). Doors opening: A mechanism for growth after adversity. Journal of Positive Psychology, 10(2), 107-115, DOI: 10.1080/17439760.2014.913669. Abstract.

Tedeschi, R. G. & Calhoun, L. G. (1998). POSTTRAUMATIC GROWTH: Positive Changes in the Aftermath of Crisis (Lea Series in Personality and Clinical Psychology).

Photo Credit: from Flickr via Compfight with Creative Commons licenses
Struggle courtesy of Neil. Moralee
Light at the end of the tunnel courtesy of Henry Hemming
Rainbow courtesy of Nêssa Florencio

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AllHealthHome and FamilySpiritualityStrengths

Positive Strokes: A Story of Post-traumatic Growth

by Miriam Akhtar
written by Miriam Akhtar

It may be easier to advocate for positive psychology when life is on an upward slope, but for me, it has been the tough times that have truly shown me the value of the science. In July less than 24 hours after facilitating the Penn Resilience Program I got a phone call which would plunge me into a test of my own resilience.

I was at the ENPP conference in Amsterdam delivering some research on bibliotherapy, when I heard that my mother had collapsed. The ensuing weeks are a blur of stress and distress. I went from a bedside vigil in intensive care to unofficial therapist in a stroke rehabilitation unit. Now I have entered into a new normal, one of role reversal, which finds me tending to my mother at the end of her life just as she tended to me at the start of mine.

What has surprised and impressed me is the growth that has occurred in the wake of this trauma, both for my mother and myself.

The Plastic Brain: Cultivate a Growth Mindset

Neuroscience has shown us that the brain is plastic and that we can develop new neural pathways throughout life. After suffering a brain injury people are going through more than just recovery. They are often having to learn a new way of living. I have witnessed this growth firsthand, observing my mother go from being unable to walk, talk, read, write or recall to recovering most of her verbal abilities and filling in the gaps by learning new strategies.

Adopting what Carol Dweck calls a growth mindset has been a key part in the recovery, putting in effort rather than relying on previous ability and aiming for progress rather than perfection. One of the optimistic things about the growth mindset is that simply knowing about its existence helps to develop a growth mindset. So I’m delivering a positive education in the subject, much to my mother’s annoyance at being lectured to by her daughter! Give a brain enough practice, rest, and hydration (as brain cells require more water than other cells for optimal functioning) and it is remarkable to see what is possible in terms of learning and relearning.

Interventions that Address Depression

Up to 50% of stroke patients experience depression and/or anxiety while in a rehab setting. Since my specialty is positive psychology interventions (PPIs) for depression, I was curious to discover which PPIs could help my own stroke patient recover her well-being.

The answer came in a moment of synchronicity from clinical psychology trainee Isla McMakin, one of the first participants of the Happiness Habits course. Isla had delivered a pilot positive intervention for stroke inpatients in Wales using Martin Seligman’s Flourish and my own book Positive Psychology for Overcoming Depression. Life after Stroke is a weekly group programme with 5 sessions covering

  1. Happiness
  2. Positive emotions
  3. PPIs for gratitude and savoring
  4. Resilience
  5. Optimism

The results of her pioneering study show a significant reduction in depression and anxiety and improvement in well-being. So PPIs have a role to play in stroke recovery.

What about Post-traumatic Growth?

I was curious to read that Isla’s study doesn’t show a significant change in post-traumatic growth (PTG), the positive psychological change experienced as a result of the struggle with highly challenging life circumstances.

Maybe it is too early in the process when stroke inpatients are still in recovery, heading for neutral on the health/disease continuum rather than into the plus scale of well-being.

Possibly they are still adapting to the new reality.

Like many family members who witness a loved one go through critical illness, this has been a trauma for me too.

Dimensions of Post-traumatic Growth

My own personal growth has occurred across all 5 dimensions of the model of PTG proposed by Tedeschi and Calhoun.

  1. Relating to others: The relationship between mothers and daughters can be fraught, but I have experienced a softening and a greater intimacy in our relationship.
     
  2. New possibilities (new roles and people): I seem to have spent the summer in a new role as an amateur rehab therapist! Joking aside I do think it is a good idea for the professionals to train family members to support the work they do. I have met some great therapists who’ve cared for my mother, and I’ve bonded with relatives of other stroke patients.
     
  3. Personal strength: I now consider positive psychology to be the pilates of the well-being world as I have found that I have more core strength than I ever knew possible.
     
  4. Spiritual change: There has been a deepening in my spirituality. This crisis has lifted me out of the minutiae of everyday life into contemplation of what life is about and its meaning and purpose. The fellowship of the gospel choir I sing in has, in particular, sustained me.
     
  5. Deepened appreciation for life: I am positively savoring every precious moment with my mother in the last days of summer.

My resilience may have been tested over the last few months but being a positive psychology practitioner has enabled me to cope positively. I have developed psychological buns of steel.
 

 

References

Akhtar, M. (2012). Positive Psychology for Overcoming Depression: Self-Help Strategies for Happiness, Inner Strength and Well-Being. London: Watkins.

Calhoun, L. & Tedeschi, R. (2012). Posttraumatic Growth in Clinical Practice. Routledge Press.

Dweck, C. (2007). Mindset: The New Psychology of Success. New York: Ballantine Books.

McMakin, I. (In press). Finding Happiness: A Positive Psychology Group for Stroke Inpatients. Contact Isla Mcmakin (Cardiff and Vale UHB – Psychology Training);

Seligman, M. E. P. (2011). Flourish: A Visionary New Understanding of Happiness and Well-being. New York: Free Press.

Teasell R.W., McRae, M.P. and Finestone, H.M. (2000). Social issues in the rehabilitation of younger stroke patients. Archives of Physical Medicine and Rehabilitation 81(2), 205-209. Abstract.

Tedeschi, R.G., & Calhoun, L.G. (2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychological Inquiry, 15(1), 1-18.

Photo Credit: via Compfight with Creative Commons licenses
Robert Wilkinson quotation courtesy of be_your_guru
Pat Marino’s recovering brain courtesy of Mikey G Ottawa. Pat Marino was a jazz guitarist who sufferend a brain aneurysm that wiped out much of his memory. He was able to relearn the guitar by studying his old recordings. More in a National Public Radio story.
Pilates instructor courtesy of heraldpost

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AllChangeRelationshipsSpiritualityStrengths

Putting the World Back Together Differently

by Kathryn Britton
written by Kathryn Britton

Flowers by a grave courtesy of Hayley Bouchard

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?

  Upsetting the apple cart courtesy of Cobalt123

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.
     

    3.   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.

 

 

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.

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AllResilience

Using Positive Psychology to Prevent PTSD

by Sherri Fisher
written by Sherri Fisher
The Army News Service formally announced last week that the U. S. Army has a new approach it hopes can prevent the psychological effects of warfare from turning into post traumatic stress disorder. The first official “master resilience training” program is one part of the Army’s Comprehensive Soldier Fitness approach aimed at enhancing physical, emotional, social, family, and spiritual soldier fitness. The resilience program is being developed and customized for the Army by the University of Pennsylvania’s resilience program. Details can be seen here.

Why train military personnel to become more psychologically fit? PTSD is crippling for many soldiers back from deployment. Moreover, according to the military, posttraumatic stress disorder affects about one out of every five returning personnel deployed to Iraq or Afghanistan. Symptoms include recurrent intrusive memories, emotional numbing, and a hyperfocus on avoiding the disorder’s symptoms, all likely to have costs to the veteran’s unit and family. Fortunately, more people who go into combat have post-traumatic growth. They’re confronted by something very difficult, and they emerge stronger as a result.

Martin Seligman says, “We can teach people to recognize the most catastrophic, unrealistic things they say to themselves when adversity strikes and to argue against the most catastrophic thoughts; realistically, to put them into perspective. This is a well-defined technique that’s been validated with tens-of-thousands of people in cognitive therapy procedures.” The US Department of Defense, in conjunction with the Veterans Administration, agrees. They list cognitive therapies with their top evidence-based interventions for PTSD.

New research (in-press) by Todd Kashdan and colleagues at George Mason University, however, showed that soldiers diagnosed with PTSD did not respond equally well to treatment, even to cognitive therapies that are considered most effective.

Kashdan’s study analyzed the content of veterans’ most important strivings–the things they wanted to accomplish in their life. Strivings, Kashdan says, are “a compass directing people toward cherished interests and values across time,” the generally important plans or aspirations of a person, the important underpinnings of our personality, hopes, and dreams. An example of an approach striving would be, “I want to be a good father,” whereas an avoidance striving might be “I don’t want to lose my spouse.”

Unlike goals, a striving does not need to have an endpoint when it will be completed. Compared to those who have approach strivings, veterans diagnosed with PTSD who strived to avoid or who focused on improving emotional self-regulation did not become happier, despite allocating significant emotional, time, and financial resources toward achieving those things for which they strived and using evidence-based cognitive interventions to support their recovery. In this study, they also experienced less purpose, meaning and joy.

At the treatment level, there is now brain imaging that can identify regions of the brain affected by PTSD. Attention and memory abilities normally moderate the exaggerated fear response which accompanies reliving a trauma. These areas are underactive in the brains of PTSD sufferers. This pattern is also seen in patients without PTSD but with anxiety, irritability, depression or insomnia. More research needs to be done to see—literally—which treatments can alleviate PTSD symptoms.

It is hoped that teaching soldiers the skills of resilience before they are exposed to the traumas of warfare will prevent many incidences of PTSD. Army Chief of Staff Gen. George W. Casey Jr. asserts, “I firmly believe that this effort to build resilience and enhance performance is fundamentally necessary if we are going to sustain this force over the coming years.”

 

 

References

Kashdan, T.B., Breen, W.E., & Julian, T. (in press). Everyday strivings in combat veterans with posttraumatic stress disorder: Problems arise when avoidance and emotion regulation dominate. Behavior Therapy

Neergaard, L. (2009). Scans show PTSD effects: May prompt earlier diagnosis. Associated Press, November 10, 2009.

 

Images
Iraq (helicopters) courtesy of The U. S. Army
devil dogs (Marines getting ready for night in Iraq) courtesy of rcvernor
BCT me and liller courtesy of Katrina*Rey
Routine Head Scan on Me courtesy of Andrew Ciscel

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