FROM SURVIVING TO

THRIVING:

A COMPARISON OF RESILIENCE

THEORY AND POST-TRAUMATIC

GROWTH

Nicole Simonson, EdS, LPC, NCC

Introduction

The literature on trauma has predominantly focused on the negative outcomes of traumatic events

More recently, a call towards incorporating each of the negative and positive outcomes has emerged.

“That which does not kill us makes us stronger.”

-Friedrich Nietzsche

What is Post-Traumatic Growth?

What is Post-Traumatic Growth (PTG)?

Term, “Post-Traumatic growth” (PTG) / coined in 1995 by Richard Tedeschi and Lawrence Calhoun-

“ Positive psychological change that occurs as the result of one’s struggle with a highly challenging, stressful, traumatic event.”

Positive psychological or life change that occurs as a result of traumatic events

Involves a movement beyond pre-trauma levels of adaptation

Develops as a result of lessons learned from exposure to trauma or crisis

Post-Traumatic growth is an ongoing process

Synonyms= Stress-related growth and benefit-finding

Post-Traumatic Growth and History

The general understanding that suffering and distress can potentially yield positive change is thousands of years old

Theme was present in ancient spiritual and religious (Judaism, Buddhism, Christianity) traditions, literature and philosophy

Scholarly interest in post-traumatic growth increased in the 1990s- given a scientific name

Emphasis was placed on studying individuals who face a wide variety of difficult circumstances experience significant changes in their lives - many of which are positive

Factors that affect PTG:

Age (older)

Gender (female)

Severity and type of stressor/trauma

Higher income

More time since traumatic event

Existential awareness (life’s fragility)

Religiosity

Higher levels of social support

Measurement of PTG

Five self-report measures to assess growth as a multidimensional construct have been developed and validated:

1. Changes in Outlook Questionnaire

2. Stress Related Growth Scale

3. Perceived Benefit Scale

4. Thriving Scale

5. Posttraumatic Growth Inventory

PTG Inventory

The Post-traumatic Growth Inventory (PTGI) is the standardized inventory most often used to measure growth that follows a traumatic life event.

It is a 21-item self-report inventory that uses a six-point Likert scale to measure positive outcomes that result from traumatic experiences.

E.g. Likert- 0-5 1. My priorities about what is important in life

2. An appreciation for the value of my own life

3. I developed new interests

4. A feeling of self-reliance

5. A better understanding of spiritual matters

In addition to an overall scale score, the PTGI comprises five factors:

Relating to others

New possibilities

Personal strength

Spiritual change

Appreciation for life

5 - Domains to PTGI

Post-Traumatic Growth

Personal Strength

Explore New Life Possibilities

Form Meaningful Interpersonal Relationships

Gain Appreciation for Life

Develop Spirituality

General Paradox-

Where there is loss, there is gain.

Domains of PTG:

1. Increased Personal Strength

-Recognition of more capabilities to deal with future challenges and adversities, and even to change situations that need to be changed.

-The subject clearly distinguishes that after the event he/she is a person with more skills and strengths, compared to the self before the trauma occurred.

-However, this greater sense of personal strength is accompanied by the perception of individual vulnerability, and by a clear understanding of the negative impact of traumatic events in one’s life.

-Recognition of possession of strength

“After going through this, I can handle anything!”

Characteristics of perceived changes in self:

Becoming stronger

More confident

New awareness of an authentic self

A ‘better self’

Deeper

More open

More empathetic

More creative

More alive

More mature

More humanitarian

More special

More humble

Domains of PTG:

2. New Possibilities/Change in Priorities

-The creation of a new life path is related

with a perception of a new philosophy of life that changes the past assumptions and core beliefs leading to new possibilities and opportunities that did not exist before the trauma.

-Taking a new path in life “Maybe I can help someone who’s gone

through this?”

Domains of PTG:

Characteristics of Changed Priorities:

How and with whom they decided to spend their day

Appearance

Nature

Monetary goods

Health

New appreciation of life (calling it a ‘gift’)

The ‘here and now’

Simple things

Time

Change life goals

Learn new skills

Go back to school

Domains of PTG:

3. Meaningful Relationships

-In dealing with the stress and loss, he/she might look for support

from family and friends.

-Increased self-disclosure= a perceived higher emotional connection in

interpersonal relationships

-Accepts the support given by others and make

better use of already existing social networks or invest in new ones

-Some relationships may become more meaningful, while others may

be weakened or even end

-New perspectives in relationships

“I cherish my family a lot more.”

Characteristics: Closer relationships with family/friends Neighbours Fellow trauma survivors Strangers Increased appreciation for significant others “True friends are”

Domains of PTGI:

4. Increased Appreciation for Life

As a result of the cognitive reconstruction, the subject has a

sense of vulnerability and recognizes he/she cannot predict or control certain events

Greater appreciation of life itself

Subject begins to pay attention to small things that were previously considered insignificant or unimportant, resulting in a change of life priorities and a greater appreciation of life.

Subject has a changed sense of what is important=

“I appreciate the smaller things in life.”

Domains of PTG:

5. Spiritual Development As a result of individual strength in confrontation with the

stressful conditions, the trauma survivors’ experiences are, in some way, an opening to religious questions or a perception of growth regarding religious or spiritual matters

Reflection of mortality

Changed worldview

Meaning and purpose in life

Finding reasons/making meaning from the trauma

‘Vulnerability’ and ‘the shortness of time’

“God carried me through it.”

Domains of PTG:

Characteristics of Enhanced Spiritual Beliefs:

Increased spirituality

Return to faith

Spiritual practices

Praying

Attending church

Gratitude to God

Strengthening of faith

Bereavement

Can be used as a coping mechanisms or as an outcome

Importance and existence differs across culture

Caveat

Don’t have to have all 5 domains to have experienced growth

May be in existence with distress

Current 5 domains may not include all aspects of growth

“The world breaks everyone and afterward many are strong at the broken places.”

-Ernest Hemingway

What is Resiliency?

Resilience Theory

An individual’s capacity to withstand stressors and not manifest psychological dysfunction.

Resiliency is the process of adapting well in the face of: Adversity

Trauma

Tragedy

Threats

Significant Sources of Stress: ‒ Family & relationship problems

‒ Serious Health Problems

‒ Workplace stress

‒ Financial Stress

Studies show that the primary factor in resilience is having caring and supportive relationships within and outside the family.

Resilience Theory

Ability to recover readily after life’s hardships

“Toughing through it.”

It’s possible that some people may be more biologically predisposed toward being resilient; but psychological and environmental factors can contribute to its development.

The good news is that resilience is not a trait that people either have or do not have – it involves thoughts, beliefs, attitudes and behaviors that can be learned and developed.

Several additional factors are associated with resilience, including: The capacity to make realistic plans and take steps to carry them out

A positive view of yourself and confidence in your strengths and abilities

Skills in communication and problem solving

The capacity to manage strong feelings and impulses

Risk and Protective factors

Risk/stress factor: A condition that increases the probability of a disorder (e.g., abuse, neglect, violence exposure, poor health care).

Protective factor: A condition that inhibits, reduces, or buffers the probability of a disorder (e.g., parental monitoring, problem-solving skills, school connectedness).

Individual risk factors

Impulsivity

Aggressive/violent behavior

Low Intelligence

Disregard for others

Sensation seeking

Language problems

Poor interpersonal boundaries

Disconnected from school/unemployed

Substance Abuse

Low self-esteem

Prenatal exposure to drugs/alcohol

Poor/irregular attachment

Unsatisfactory relationships

Biological risk factors (head injury, infection, nutrition, exposure to toxins)

Acute health condition

Family risk factors

Family history of mental illness

Parental crime/incarceration

Familial abuse/neglect

Familial substance abuse

Lack of parental support

Family isolation

Large family size

Death of a caregiver

Physical/mental illness of a loved one

Individual protective factors

Social

Competence Autonomy

Sense

of

Purpose

Problem

Solving

Responsiveness

Communication

Empathy/ Caring

Compassion Altruism

Forgiveness

Planning

Flexibility

Resourcefulness

Critical Thinking

Insight

Goal Directed Achievement

Motivation

Optimism/

Hopefulness

Faith/ Spirituality

Sense of Meaning

Positive Identity

Internal Locus

of control

Self-efficacy Mastery

Adaptive

Self-Awareness

Humor

Key Characteristics of Resilience

Locus of Control

A personality trait which can affect resilience levels.

Developed by Julian Rotter in 1954: The extent to which individuals believe they

can control events which affect them. OR

The control individuals feel they have over the environment around them.

Everyone sits on a continuum between having an internal

or external locus of control.

Locus of Control

• Enjoyment • Interest • Self Esteem • Sense of achievement • Desire to win

• Salary/bonuses • Job security • Approval/praise/pleasing others • Promotion • A prize

INTERNAL

EXTERNAL

PTG vs. Resilience

In contrast to resilience:

PTG refers to a change in people going beyond an ability

to resist and not be damaged by highly stressful circumstances

Involves a movement beyond pre-trauma levels of adaptation

Subjects with PTG have coping strategies that allow them to be less challenged by trauma

The struggle with trauma may be crucial for posttraumatic growth, not trauma itself

PTG vs. Resilience

Resilience in children exists prior to exposure to trauma or a stressful life experience.

Resilient individuals have a high level of coping after trauma.

Post-traumatic Growth in children develops as a result of lessons learned from exposure to trauma or crisis.

Post-traumatic growth is manifested in several clearly defined behaviors and thought patterns not necessarily present prior to exposure.

PTG vs. Resilience

The following factors are associated with resilience in children:

Above average communication skills, cognitive abilities, and problem-solving abilities

Positive beliefs about self and future talents, hobbies, and/or special skills

Ability to self-regulate behavior

Able to ask for help from adults

Stable, nurturing parent or caretaker and extended family

Supportive, positive school experiences

Consistent family environment such as family traditions, rituals, and/or structured routines

Strong cultural connections and cultural identity

What is my part?

Clinical Implications for Resilience and PTG

Three facets of Resilience

Recovery Stressor disrupts a person’s normal state of functioning

When stressor passes, person resumes her normal pre-stressor level of functioning

Resistance People who exhibit normal functioning before, during,

and after a stressor (even long after a stressor)

Reconfiguration Individuals reconfigure their cognitions, beliefs, and

behaviors in manner that allows them to adapt to traumatic experiences

Possibly withstanding future trauma

PTG in Clinical Practice

A more inclusive framework for treating stress response

Not a new “SCHOOL OR MODALITY” of therapy

Can be combined with any school of thought

Not a new “TECHNIQUE”

Works best with cognitive, narrative and existential approaches

Expert Companion

Clinician as expert companion Facilitator of PTG process

Not direct Not called a therapist

Open to being changed

Walks a step behind the client guiding the client

Patience and Trust

Without companionship, expertise is hollow

Downplay expertise

Stories need to be told, and experiences need to be understood--takes time and good listening

Model of Post-Traumatic Growth

Traumatic event distress shattering of

basic beliefs Automatic rumination and intrusions Active cognitive processing event New, adaptive assumptions Opportunities to find new meaning in

traumatic event to achieve PTG

PTG Model Elements

The person pre – trauma

Characteristics of trauma survivor

Assessment of client’s strengths

“How have you handled stress in your life prior to the trauma?”

Old crises can also provide a fruitful source for recognizing growth that the individual has already experienced.

Help the client construct a new set of beliefs about self using the evidence of adaptive coping with trauma.

“I’ve noticed something in you that you tend to overlook in yourself.”

PTG Model Elements:

Seismic Event Trauma as an Adaptation Process

Focus is on the aftermath of traumatic event

Difference in PTG and Trauma-focused therapy is in Trauma-Focused therapy, will spend more time on the trauma itself.

Redirect to what is happening after the trauma.

How are you doing in life? Where are you looking for your strengths? Things to incorporate in life?

Will not try to keep you in the traumatic moments.

PTG Model Elements

Rumination and Cognitive Elements

Brooding rumination versus reflective rumination

Expert companion establishes safety, listens carefully, encourages disclosure, avoids platitudes, and tolerates distress in survivor

Guides client through cognitive processing

Helps client get unstuck by proposing a new angle of the event by asking questions of its meaning and purpose

Therapeutic advice for clinicians:

Become the expert companion

Learn from the client

Do not engage in direct attempts to foster growth

Must be aware of growth themes

Listen for themes

Acknowledge themes in the clients own words

Arise as result with struggle, not as result of events only

Do not deny distress

If no signs of delusion, go with the clients understanding (positive illusions or not)

Do not solely use it as the sign of good intervention

Remember- not universal

Tolerance: Cultural and individual

considerations

Respect and work within the trauma survivor’s framework.

Tolerate “positive illusions.” Don’t underestimate people’s capabilities

Be willing to explore spiritual or religious views.

PTG and Mental Health

Negative relationship with depression and anxiety

Reduced alcohol and substance abuse Lower levels of general and emotional

distress Positively correlated with hope, optimism

and positive affect Enhanced Quality of life (Qol)

PTG and Physical Health

Lower cortisol levels

Greater immune system functioning among HIV patients with higher

levels of PTG

High PTG scorers, with hepatoma, survived 186 days longer than their

lower scoring peers

Less AIDS related mortality with self-reported benefit finding among HIV

positive men who had recently had someone close to them die of AIDS

Positive psychology may be running before it can walk in applications to

cancer care

Questions/Answers?

References

Armour, M. (2007). Violent Death. Journal of Human Behavior in the Social Environment, 14(4), 53-90.

Brokenleg, M. (2012). Transforming Cultural Trauma into Resilience. Reclaiming Children And Youth, 21(3), 9-13.

Betancourt, T. S., & Khan, K. T. (2008). The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Psychiatry, 20(3), 317-328.

Cloitre, M., Martin, N., & Linares, O. (2005). Children's resilience in the face of trauma. New York, NY: University Child Study Center.

Goodman, R. D. (2013). The transgenerational trauma and resilience genogram. Counseling Psychology Quarterly, 26(3/4), 386-405. doi:10.1080/09515070.2013.820172

Johnson, S. F., & Boals, A. (2015). Refining our ability to measure posttraumatic growth. Psychological Trauma: Theory, Research, Practice, And Policy, 7(5), 422-429. doi:10.1037/tra0000013

References

Joseph, S., Murphy, D., & Regel, S. (2012). An Affective-Cognitive Processing Model of Post-Traumatic Growth. Clinical Psychology & Psychotherapy, 19(4), 316-325. doi:10.1002/cpp.1798

Levine, S. Z., Laufer, A., Stein, E., Hamama-Raz, Y., & Solomon, Z. (2009). Examining the relationship between resilience and posttraumatic growth. Journal Of Traumatic Stress, 22(4), 282-286.

Lyon, C., & Parkins, J. R. (2013). Toward a Social Theory of Resilience: Social Systems, Cultural Systems, and Collective Action in Transitioning Forest-Based Communities. Rural Sociology, 78(4), 528-549. doi:10.1111/ruso.12018

McElheran, M., Briscoe-Smith, A., Khaylis, A., Westrup, D., Hayward, C., & Gore-Felton, C. (2012). A conceptual model of post-traumatic growth among children and adolescents in the aftermath of sexual abuse. Counselling Psychology Quarterly, 25(1), 73-82. doi:10.1080/09515070.2012.665225

References

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