The Trouble with Post-Traumatic Growth

You may have heard of post-traumatic growth. It's been touted in the New York Times ("the surprisingly positive flip side of PTSD"), studied in countless empirical papers, and sermonized in TED talks, books, and academic research centers. It's one of those zeitgeist ideas upon which entire empires are built: First, we had PTSD, but now we have post-traumatic growth.

Source: Anthony Mancini

The basic principle is this: Something terrible happens, and in the weeks and months that follow, we have trouble not thinking about the experience. We avoid reminders of it, and we have intrusive memories that pop into our heads and ratchet up our anxiety. We are debilitated by these symptoms. But at some unspecified time later—perhaps years after—we grow from that trauma, and we become a better person. We become wiser, stronger, more accepting of others; we develop closer relationships and have more compassion for others; we change our philosophy of living, re-evaluate our priorities, and become more spiritual. All in all, we are better, because we were traumatized.

It's an immensely appealing idea. Who wouldn't want it to be true?

The only problem is: There's very little evidence for it. Wait, didn't you just say that countless empirical papers have been published on post-traumatic growth?

Yes, but here's what almost all of those studies do. They ask people who have experienced a potentially traumatic event whether they are better off because of it. And in fact, many people report that they are indeed a better person. They have grown. They see new possibilities in life. They are able to find in their suffering a bright kernel of redemption.

But does this mean they actually are better? In other words, are they actually wiser, more compassionate, and closer to others? Or do they just perceive that they are?

Perceived Growth and Actual Growth Are Two Different Things

It turns out that it is very difficult to separate these two things: the perception that we are better and the actuality that we are. In fact, almost no studies separate perceived and actual growth for a very good reason. It is extraordinarily difficult to know how someone is doing before a trauma occurs.

One remarkable study did just that: They measured a large sample of undergraduates (N = 1,528) at the beginning and the end of a semester. They then identified a group of participants who experienced a traumatic event during the semester that caused considerable distress (n = 122). They asked whether they had grown from the trauma (including "I have a greater feeling of self-reliance" or "I am able to do better things with my life").

In theory, among this trauma-exposed group, if you perceived that you grew from the trauma, you should actually show improvements in your overall functioning. In other words, when you say you think you are better (perceived growth), you are in fact better (actual growth). Well, the researchers found that the perception of growth was unrelated to actual growth. Moreover, the perception of growth was linked to more distress at the semester's end.

In short, just because someone believes that they are better off does not mean that they are. In fact, it may very well mean that they are not.

Perceived Growth Is Likely a "Positive Illusion"

Why would someone perceive that they have grown when they have not? One explanation is that perceiving growth is a way of coping with the event itself. In this framework, post-traumatic growth isn't growth at all. It’s a "motivated positive illusion" whose purpose is to protect us from the possibility that we may have been damaged. In fact, one unusually rigorous experimental study found that when an event threatens our sense of self, we are more likely to believe that the event made us better in some way.

Alas, this coping strategy is ineffective. People who perceive growth tend to do worse over the short and the long term compared to people who don't. How do we know? One recent study looked at soldiers returning from a deployment to Iraq. They found that soldiers who reported posttraumatic growth five months after returning home saw an increase in PTSD symptoms at 15 months. Another study published this year on survivors of the Oslo bombings, the horrific 2011 massacre in Norway, found the exact same result—early posttraumatic growth = later PTSD. In short, perceiving growth portends worse functioning, not better.

Are There Benefits to Adversity?

Does this mean we cannot benefit from adversity? Absolutely not. But before we can understand how, we have to distinguish between perceptions of change and actual change. When we conflate the two, we walk ourselves down the garden path.

In my next blog post, I'll discuss an alternative to post-traumatic growth that emerged in a recent paper of mine on survivors of the Virginia Tech campus shootings. We'll see there how acute adversity can be—strangely and sometimes—just what the doctor ordered.