Posttraumatic Growth and Recovery

This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.

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Posttraumatic Growth and Recovery by J. Kyle Haws

Although often the focus is on traumatic events and experiences can cause long-term damage to people, physically and mentally, the truth is much more complex. Indeed, people often grow stronger after experiencing a traumatic event, what we call posttraumatic growth. In one well-known fictional example, Batman became a beloved crime fighter and superhero after witnessing the murder of his parents, rather than succumbed to grief and depression.

Approximately 80% of the population is likely to experience a traumatic event sometime during their life; however, only a relatively small percentage actually develops a mental disorder as result. Human species have evolved through millennia of trauma and the usual response to high adversity is growth. This growth occurs as a result of adversity and is called posttraumatic growth. What is posttraumatic growth? The term posttraumatic growth (PTG) refers to the phenomenon of people becoming stronger and creating a more meaningful life in the wake of tragedy or trauma. PTG is not about returning to the previous life, that would be resilience, but rather undergoing significant life changing shifts that contribute to a more meaningful life. A significant number of individuals will show intense depression and anxiety after a traumatic event, but they will then grow psychologically and emotionally as a result.

“What does not kill us makes us stronger,” said by Nietzsche is an accurate representation of PTG. The idea that suffering and trauma can produce positive change is not new. These ideas can be found in writings of the ancient Hebrews, Greeks, as well as the teaching in Christianity, Buddhism, and Islam. What is new is the systematic study of PTG by psychologists, social workers, and counselors. PTG has occurred following various natural and man-made traumatic events, including life-threatening disease, war, abuse, and death of loved ones. PTG is found in many countries and across different cultures. PTG is a renewed appreciation of life, acting on new opportunities, improved relationships, and enhanced personal strengths, which often follow tragedy.

How does PTG differ from resilience? Some researchers speculate that PTG is an extension of resilience, while others suggest that resilience plays a pivotal role in the development of PTG. There is evidence of a negative relationship between PTG and resilience. Individuals who score highly on resilience experience less PTG. Individuals who score highly on resilience may have stronger coping skills and are less likely to suffer from trauma and experience growth from the trauma.

There is evidence that individuals who have experienced a horrendous event in their life have higher wellbeing and more intense strengths than individuals who have not experienced any catastrophic events. Individuals who have been through two horrific events experience more growth than individuals who have one, and individuals who have three horrific events are stronger than those with only two. In a study of imprisoned airmen 61% of them reported benefiting psychologically from their imprisonment. The more severe their torture, the greater their posttraumatic growth.

Rhonda Cornum’s experience as a Brigadier General in the Gulf War is an example of PTG. In 1991, Rhonda was on a rescue mission in Iraq when her helicopter was shot down. All but three of the eight on the helicopter were killed. Rhonda was taken prisoner with both arms and legs broken. As a prisoner she was sexually assaulted and tortured for eight days. After she was released Rhonda experienced significant growth from the horrendous experience. She describes feeling more empathetic to the concerns of her patients. Her self-confidence blossomed and she felt that she was better equipped to be a leader because of the experience. She obtained a greater appreciation for her family and was more attentive towards her children and her spouse. Her priorities changed as a result of the trauma, she felt more inclined to spend time with her children and enjoy the little things life offered.

Every soldier going to war has heard of PTSD. At West Point 90% of the cadets had heard of PTSD, but less than 10% had heard of PTG. If an individual only knows about PTSD, and not about resilience, it creates a self-fulfilling prophecy. Imagine you are serving in Iraq and your comrade is killed yesterday. Today you burst into tears, and you think, I’m falling apart; I’ve got PTSD; my life is ruined. These thoughts increase the symptoms of anxiety and depression. PTSD increases in likelihood because of the self-fulfilling nature of the downward spiral that catastrophizing and believing you have PTSD engenders.

Individuals you are catastrophizers are more susceptible for being diagnosed with PTSD. One study followed over five thousand soldiers for five years. During this five year period, 8% of the soldiers were diagnosed with PTSD. A majority of the soldiers diagnosed with PTSD were in the bottom 15% of mental and physical health. So the people who are in bad mental and physical shape to begin with are at greater risk for PTSD than those you are more psychologically and physically fit.

Personality traits and mood states, such as extraversion, optimism, positive affect, and openness to experience have been associated with PTG. Neuroticism has been significantly associated with PTG. Gender and socioeconomic status is also associated with PTG. All of these characteristics play a fundamental role in how an individual pursues their life goals during catastrophic events. Several other factors have been associated with growth after catastrophic experiences. Social support is a significant buffer from mental illness and stress response. The ability to accept situation that cannot be changed is necessary for growth.

The majority of us will face difficult losses or great suffering during out lives. Distress is typical and normal after traumatic events. Traumatic events are not good and do not always produce growth. Ideally catastrophic loss and grief can be avoided, but if not hopefully posttraumatic growth can also be experienced.