Promoting Post-Traumatic Growth After PTSD
While many reactions to trauma are harmful, some may actually result in growth.
Posted Sep 05, 2018
By Mario Guzman, Ph.D., and Ferran Padros, Ph.D.
In the U.S., there is a large number of people who struggle with Post-traumatic Stress Disorder (PTSD) as a consequence of one or several traumatic experiences. According to the U.S. Department of Veterans Affairs, an estimated 8 percent of Americans could have PTSD at any given time—that is 24.4 million. Between 11 and 20 percent of veterans who were involved in Operations Iraqi Freedom and Enduring Freedom have PTSD. Also, an estimated 12 percent of Gulf War veterans are coping with PTSD, as well as 30 percent of Vietnam veterans. But it is not only the military population who has to struggle with this problem; anyone can. There are several kinds of experiences that can lead to trauma and the problems associated with it: child abuse, sexual abuse, shooting victims, kidnappings, assault, bullying, domestic violence, amongst others.
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are four main cluster symptoms for PTSD: avoidance symptoms, re‐experimenting symptoms, hyperarousal symptoms, and negative changes in beliefs and feelings. It is common for people with PTSD to try to avoid thoughts, conversations, and situations that can trigger memories of the traumatic events. Paradoxically, this avoidance will lead to an increase in re‐experimenting symptoms, such as nightmares, flashbacks, and intruding thoughts related to the traumatic experience. These avoiding and re‐experimenting symptoms would prolong arousal symptoms like sleeping problems, difficulties trying to get concentrated, irritability, and hypervigilance.
After this, the negative beliefs and feelings would be reinforced due to what Daniel Wegner called ironic rebound, or the "white bear problem." This is a process in which the intent of suppressing thoughts makes them more likely to happen. The ironic rebound happens, because while a conscious part of us is trying to suppress the thoughts, another unconscious part of us is monitoring whether we are successful in our task or not. As a result of this, a paradoxical effect takes place, and more thoughts appear. To make this explanation simple, stop reading this article now and try not to think about a polar bear for the next minute. After that minute, ask yourself if you were successful at the task, and then come back to read our article.
The types of beliefs and feelings that people with PTSD try to suppress could be: negative thoughts about oneself, others, and the world; guilty thoughts about the traumatic event; negative mood; lack of interest in meaningful activities; and inability to have positive feelings, such as happiness, satisfaction, or love.
There are different ways to experience trauma. Some people will experience the symptoms just after the traumatic experience, while others will struggle with them six months after the event or even years later. For some of them, the disorder can be a short experience, which will last less than three months. But for others, it could be chronic, and it could even take them years to deal with the symptoms.
Several data shows that there are three main treatments that work for people diagnosed with PTSD: Cognitive and Processing Therapy (CPT), Prolonged Exposure Therapy (PT), and Eye Movement and Desensitization Reprocessing (EMDR). All of these therapies work by processing the traumatic experience, and they are short-term therapies (8 to 12 sessions). There is even new research showing that shorter treatments seem to work too.
However, there is another area of opportunity for patients with PTSD that many people do not know about; it is called Post-traumatic Growth (PTG). Tedeschi and Calhoun, from the University of North Carolina, found that several survivors of traumatic events experienced personal growth in areas such as appreciation of life, relationships, and new opportunities, as well as an increased sense of their own strength and spirituality. These changes are not universal, which means that not all of those who go through trauma will develop PTG, and we shouldn’t think that going through trauma is desirable or positive, but it has been proven that some people will experience this positive outcome. There’s no clear reason why some do, while others don’t, but there’s interesting information that gives us clues. For example, research shows that people who were highly resilient before the trauma would be unlikely to develop PTG; we also know that those who don’t have social support after the trauma would be less likely to experiment PTG. What we know for sure is that there are people experiencing growth after trauma.
With this information, Dr. Ferran Padros and I wondered if we would be able to promote or enhance PTG in people experiencing PTSD. A few years ago, we developed a short-term training (consisting of only four meetings) in PTG, and we started a protocol to see how it works in action. We conformed two randomized groups of patients, who had been previously diagnosed with PTSD. One of these groups, the control group, received Cognitive and Processing Therapy (CPT), which has shown great effectiveness in treating PTSD through several studies. The second group, the experimental group, received the same therapy, CPT, and the training in PTG that we developed.
We found that both groups were equally effective in diminishing the PTSD symptoms; none of the participants was diagnosed with PTSD after the treatments. And we also found that patients in both groups experienced PTG, which is great news, but we also found that those in the experimental group, the ones who received the PTG training, showed better scores in psychological well-being, which was also tested in the experiment.
Some conclusions are proposed:
- Some people who go through trauma can benefit and achieve personal growth.
- If those with trauma receive therapy, it is more likely that they will develop said growth.
- A short-term training added to traditional treatment ensures that people could experience more personal growth and psychological well-being.
Even though these results are promising, there are still issues to be considered. For example, it would be interesting to learn whether these results are repeated if other research and other types of therapies for PTSD are applied. Also, it is necessary to have a bigger sample of subjects to have more accurate results and conclusions. But for the moment, it is very encouraging to know that after all the grief, sorrow, and anxiety that people suffer because of trauma or PTSD, they may not only feel better, but also perceive growth and psychological well being in different areas of their lives. If the results of the research can be replicated, it would mean that there is light at the end of the tunnel for many people.
Our research can be consulted in the International Journal of Psychology and Psychological Therapy.