The Many Layers of Post-Traumatic Growth

Psychologist Richard Tedeschi shares his research and insight into the concept of growth as a potential consequence of grappling with trauma.

In the past decade due to the conflicts in Iraq and Afghanistan, the term post-traumatic stress disorder has become the focus of countless headlines and has entered the collective conscience. But it is far from a new concept. During previous wars in history, the term for PTSD was known as soldier’s heart, shell shock, battle fatigue, and war neurosis, among others. As ancient, is its flipside: post-traumatic growth.

The term was coined in 1995 by Richard Tedeschi, PhD and Lawrence Calhoun, PhD to focus on the idea of growth as a potential consequence of grappling with trauma. There have always been people who, faced with a major life crisis or trauma, have been able to use that opportunity to make positive, meaningful change.

BrainLine talked with Dr. Tedeschi about post-traumatic growth, why some people seem to experience it while others don’t, and how it can help transform a person’s life into something far better than ever imagined. A psychologist at the University of North Carolina, Charlotte, Dr. Tedeschi is a researcher and a clinician.

BrainLine: What is post-traumatic growth, exactly?

Richard Tedeschi: The term post-traumatic growth (PTG) has been defined as the experience of positive change resulting from the struggle with major life crises. The concept is, of course, ancient and has been prevalent in the literature, philosophy, and religion of almost all cultures.

It’s important to note that we’re not talking about the traumatic event itself, but how the event becomes a catalyst for positive change. PTG is the process after the traumatic event.

BL: Why did the topic interest you in the first place?

RT: Lawrence Calhoun and I, both at UNC, decided we wanted to study wise people, resilient people. Maybe we’d learn something about ourselves in the process, right? We started interviewing survivors of severe injuries, people who had survived something physical or emotional in their adult life like a brain injury, blindness, paralysis, or being held as a prisoner of war (POW). Over and over, we heard how people and their families were deeply saddened by the losses and changes, but nevertheless, the experience had changed them for the better.

BL: In what parts of people’s lives does PTG tend to emerge after a trauma?

RT: While studying the concept of PTG over many years, Lawrence Calhoun and I established five domains in which PTG can arise most prevalently. We did this by statistical analysis; basically, conducting a series of interviews with survivors of severe injuries. As we heard about the changes these people went through after their life crisis, we created general statements and the following areas, or domains, emerged:

• new opportunities or possibilities in life
• increased sense of personal strength
• change in relationships with others
• greater appreciation for life in general
• deepening of spiritual life

Some of the statements included sentiments like “I realize the importance of being present in daily living”; “I have more compassion for others; I’m more open”; “I can accept help from others more easily”; and “I can do things I hadn’t considered before.”

BL: Is there a certain type of person who is more prone than others to experience PTG?

RT: I’d say the type of people who may tend to experience PTG are those who would actively approach difficulty rather an avoid it. Someone who is open to change, open to the novelty and serendipity of life. People who can accept that bad things happen, that they can no longer do certain things, but who focus on engaging in the things that they can still do. And people who are open to new opportunities … possibilities and choices that may not have presented themselves before the tragedy.

BL: Why do some people emphasize what they have lost while others take that loss and turn it into a gain or opportunity?

RT: I know this sounds counterintuitive, but people who were less resilient before their tragedy tend to be more open to PTG. If someone is already resilient, he doesn’t need to change so drastically. PTG involves big change.

BL: People must experience some negative feelings and positive feelings after a trauma. How does this ambivalence manifest itself? Do you work to help the person get rid of the negative feelings and only work on the positive, or to see a yin-yang-type balance?

RT: To move toward PTG, you have to go through a phase of intense reflection. A person has to get through the emotional pain following a serious injury or trauma, a phase that is necessary but is non-productive in moving forward. Once dealing with the feelings of loss, anger, and other emotional pain is done, a person can then reflect and begin to let in opportunities for change and growth. A lot of this process depends on the type of support a person receives. If you are surrounded by loving people who are encouraging change and reflection, you will be in a better spot to grow than if you are surrounded by people who are naysayers to your ideas of how you might want to change and grow.

Most people who have traumatic events don’t get professional psychological help. They may instead rely on family and friends, or community. And again, the attitude and support of those people will play a huge role in a person’s ability to grow post-tragedy.

If a person does seek the help of someone like me, I will ask the person to tell me the story of what happened — how he got his brain injury, or how he became a quadriplegic. From there, we will work on tools to deal with non-constructive emotions like anger or self-pity. I will help the person get to a point where he is open to new opportunities, to new ways of seeing and living in the world. This is called expert companionship.

BL: What is that?

RT: An expert companion can be a therapist like me. It could also be a person in a social network who has gone through a similar tragedy who understands and who can act like a positive mentor. Or if the person is lucky, it can be a family member or friend. The expert companion needs to be open to hearing the person’s story, to hearing his feelings and emotions no matter how intense and repetitive in the long haul. This expert needs to be able to tolerate challenging, confusing, uncomfortable questions in the aftermath of the person’s trauma. The expert companion will not offer platitudes or quick fixes; above all else, he has to be a good listener. The expert also needs to be able to help the person see opportunities for useful change and to encourage him in the aftermath of this trauma to find some benefits. Everyone is different. An expert companion cannot make assumptions; he has to understand what this person has gone through, where the person came from, and how this brain injury, paralysis, or experience as a POW, for example, changes everything.

BL: Does the type or severity of trauma have some bearing on a person’s ability to experience PTG?

RT: The more severe the event, the more post-traumatic growth we’ll see. For example, if you get in a fender-bender in the parking lot, you may be shaken for a few days or weeks, but the incident will probably not prompt you to make significant changes in your life. While if you have been in a serious car crash where you almost died, you will probably be open to bigger change. After a more significant trauma, you will likely have more questions and thoughts about mortality, about how you want to spend your time on Earth.

BL: Is there an average time frame where people start to experience fewer negative reactions to their trauma and move more into the PTG camp? And does the level of someone’s PTG grow or diminish as more time elapses since the traumatic event?

RT: In our studies, we have found that PTG generally occurs most commonly in the short to medium term, around 1-2 years. Once the emotional processing from the tragedy is mostly over, people can move quickly into the opportunities for new change and growth.

We recently finished a study with POWs from Hanoi. They were evaluated directly after the Vietnam War. Our study retested them. We found stability in the PTG changes that they made; they made significant changes and kept them all these years.

There are other instances when people come back to us with concerns. I had one patient who had cancer. The diagnosis made him reevaluate his life and his priorities and he made significant changes on how he lived his life. Five years after his treatment ended, he returned to me to say that he thought he was “losing his edge,” that the changes he’d made were fading. He said he did not want to return to who he was before his cancer diagnosis. But most times, like the POWs prove, people tend to stick with the changes they made in the wake of tragedy.

BL: Are there certain actions that a person takes that manifest PTG?

RT:  When people make radical changes after a significant life tragedy or trauma, they usually put into action what is changing about them. They develop a mission, a purpose so that they can live differently. Their purpose is often altruistic in nature. For example, we treated a guy who because of a car crash became a paraplegic. As a result, he transformed from a stereotypical drug-taking, risk-taking rock-and-roll musician to a rehabilitation psychologist who works with disabled people. Because of his experience, he is able to relate to his patients on a deeper level and offer genuine encouragement. He turned what was horrible into a way to benefit others. He told me that he felt very grateful for the accident and how his life changed. If it hadn’t, he said, he would never have found this path, which to him is his true calling.

BL: How can clinicians use interventions to encourage PTG?

RT: Clinicians have to give the person’s traumatic event enough respect but at the same time, encourage the person to see directions that are still open to them.

For someone with a TBI, for example, the person may have been very capable and successful in the traditional sense before his injury. And now, post-injury, it may be hard for him to see a way to be successful. Working with him would entail helping him to redefine success. It would entail philosophical discussions, careful, attentive conversations. There are no easy answers, but to examine what it means to live a well-lived life can open up many possibilities for positive change.

Working with a person who has sustained a TBI depends greatly on the level and location of injury. Sometimes, we start simply by helping the person gain awareness of what abilities are still available to him. Then we might help reteach social skills in a deliberate way and teach him how to deal with his emotions. Once some of the more pragmatic skills are relearned, there will be more opportunities for that person. We had one woman in her 20s whose brain injury left her disabled. She had been in a doctoral program; she had been a champion swimmer. Now she had to walk with a walker and she had a hard time writing and thinking clearly. What had once been her strengths were no longer. She did a lot of work with us to learn to accept, without anger, that people saw her differently now, saw her as diminished. Her struggles helped transform her into a more compassionate person.

Another guy we worked with had a stroke at 40 years of age. Because of the stroke, he learned that he had a genetic anomaly in his heart that could cause an aneurysm at any time. Any exertion, any raise in his blood pressure might trip the weakness. So, he learned to live each day as if it were his last. He learned that his role in life after his stroke was to live calmly, slowly, and presently. He lives a sort of meditative lifestyle, listening and noticing the small details of the world. He found he became closer to his wife and children than he ever would have been had he continued his previous, frenetic lifestyle.

It is crucial to understand that PTG does not make everything all better; it does not make all the stress disappear. But it can bring true meaning to a person’s life. PTG forces us to focus on bigger questions — questions and concepts about wisdom, virtue, and values.

BL: Have you made any changes in your life based on what you’ve learned working with people who have experienced trauma?

RT: I have come to feel a great deal of respect for survivors of various traumas, and hope that I can handle my own with as much grace as many of my clients have. I do try to savor things, and separate the important from the trivial.  I try to catch myself when I am overreacting, and remember what is truly important. I also realize more acutely what I am doing wrong with my life, and struggle to change — sometimes with good effect, sometimes not. I am a work-in-progress and am still trying to learn, and my clients who have survived trauma are often excellent teachers.