Posttraumatic growth

Post-traumatic growth refers to positive psychological change experienced as a result of the struggle with highly challenging life circumstances. These sets of circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to individuals' way of understanding the world and their place in it. Posttraumatic growth is not simply a return to baseline from a period of suffering; instead it is an experience of improvement that for some persons is deeply meaningful.

History
The general understanding that suffering and distress can potentially yield positive change is thousands of years old. For example, some of the early ideas and writing of the ancient Hebrews, Greeks, and early Christians, as well as some of the teachings of Hinduism, Buddhism, and Islam contain elements of the potentially transformative power of suffering. Attempts to understand and discover the meaning of human suffering represent a central theme of much philosophical inquiry and appear in the works of novelists, dramatists and poets. Scholarly interest in post-traumatic growth began to gain considerable strength in the 1990s, based on the idea that greater interest should be placed on studying people who are actually healthy, and the better and brighter aspects of human behavior. Today, there is overwhelming evidence that individuals facing a wide variety of very difficult circumstances experience significant changes in their lives many of which they view as highly positive. Posttraumatic growth has been documented in relation to various natural and human made traumatic events, including life threatening disease, war, abuse, immigration and death of loved ones. It has also been documented in many countries and in the context of different cultures with evidence that PTG is a universal phenomenon but also manifests some cultural variations. Growth from trauma has been conceptualized not only for individuals but also for families as systems.

Causes
Posttraumatic growth occurs with the attempts to adapt to highly negative sets of circumstances that can engender high levels of psychological distress such as major life crises, which typically engender unpleasant psychological reactions. Growth does not occur as a direct result of trauma, rather it is the individual's struggle with the new reality in the aftermath of trauma that is crucial in determining the extent to which posttraumatic growth occurs. Encouragingly, reports of growth experiences in the aftermath of traumatic events far outnumber reports of psychiatric disorders, since continuing personal distress and growth often coexist.

As far as predictors of Post-Traumatic Growth, a number of factors have been associated with adaptive growth following exposure to a trauma. Spirituality has been shown to highly correlate with post-traumatic growth and in fact, many of the most deeply spiritual beliefs are a result of trauma exposure (O'Rourke 2008). Social support has been well documented as a buffer to mental illness and stress response. In regards to Post-Traumatic Growth, not only is high levels of pre-exposure social support associated with growth, but there is some neurobiological evidence to support the idea that support will modulate a pathological response to stress in the Hypothalamic-Pituitary-Adrenocortical (HPA) Pathway in the brain (Ozbay 2007). It is also alleged, though currently under further investigation, that opportunity for emotional disclosure can lead to post-traumatic growth though did not significantly reduce post-traumatic stress symptomology (Slavin-Spenny 2010). Gender roles did not reliably predict post-traumatic growth though are indicative of the type of trauma that an individual experiences. Women tend to experience victimization on a more individual and interpersonal level (e.g. sexual victimization) while men tend to experience more systemic and collective traumas (e.g. military and combat). Given that group dynamics appear to play a predictive role in post-traumatic growth, it can be argued that the type of exposure may indirectly predict growth in men (Lilly 2012).

Characteristics
Results seen in people that have experienced posttraumatic growth include some of the following: greater appreciation of life, changed sense of priorities, warmer, more intimate relationships, greater sense of personal strength, and recognition of new possibilities or paths for one's life and spiritual development. Two personality characteristics that may affect the likelihood that people can make positive use of the after-math of traumatic events that befall them include extraversion and openness to experience. Also, optimists may be better able to focus attention and resources on the most important matters, and disengage from uncontrollable or unsolvable problems. The ability to grieve and gradually accept trauma could also increase the likelihood of growth. It also benefits a person to have supportive others that can aid in post-traumatic growth by providing a way to craft narratives about the changes that have occurred, and by offering perspectives that can be integrated into schema change. These relationships help develop narratives; these narratives of trauma and survival are always important in post-traumatic growth because the development of these narratives forces survivors to confront questions of meaning and how answers to those questions can be reconstructed. Individual differences in coping strategies set some people on a maladaptive spiral, whereas others proceed on an adaptive spiral. With this in mind, some early success in coping could be a precursor to posttraumatic growth. A person's level of confidence could also play a role in her or his ability to persist into growth or, out of lack of confidence, give up.

A recent article by Iversen, Christiansen & Elklit (2011) suggests that predictors of growth have different effects on PTG on micro-, meso-, and macro level, and a positive predictor of growth on one level can be a negative predictor of growth on another level. This might explain some of the inconsistent research results within the area.

Another characteristic of posttraumatic growth is it can coexist with negative psychological adjustment after traumatic events, so it is important that measures of grief used in both clinical and research domains allow for an assessment of positive response.

Related concepts
In contrast to resilience, hardiness, optimism, and a sense of coherence, post-traumatic growth refers to a change in people that goes beyond an ability to resist and not be damaged by highly stressful circumstances; it involves a movement beyond pre-trauma levels of adaptation. It could be possible that people who are highest on these dimensions of coping ability will report relatively little growth. That is because these people have coping strategies that will allow them to be less challenged by trauma, and the struggle with trauma may be crucial for post-traumatic growth.