Mizuta Masahide, a 17th century Japanese poet and samurai, once said “my barn having burned down, I can now see the moon.” It’s inspiring to imagine such an admirable response to such tragedy. A disaster took his home, but he found something new, something glowing. I had the wonderful opportunity to work with the brave men and women who were first responders to the World Trade Center on 9/11. These men and women witnessed the deaths of thousands of innocent people, trying to protect themselves and others around them. Many of them are still haunted by the memories, by the fear, by the sense of helplessness. However, many have recovered from this traumatic experience, and found mental stability following this disaster. They went on to lead courageous lives. This devastation tore down the world many of us once knew, instilling fear, anger and grief for years to come. Yet, in an encouraging way, some of these first responders actually grew from this. It changed their beliefs about the world for the better. It inspired them to help others. It made them stronger, and more fearless. They had a new appreciation for life. These people, who grew from this trauma, saw the moon.
There are many possible outcomes to consider following the experience of a traumatic event. Some may experience negative mental health impacts, which may impair their daily functioning for years to come. Others may experience these negative impacts, but eventually recover, returning to normal levels of functioning after a certain period of time. Some people flourish, interestingly, reporting changes that exceed their functioning before the traumatic event. Post-traumatic growth, a concept first described in 1996 by licensed psychologists Richard Tedeschi, PhD and Lawrence Calhoun, PhD, describes this exact change (1996). With post-traumatic growth, individuals not only recover from trauma, but use it as an opportunity for personal development (Zoellner & Maercker, 2006). Indeed, post-traumatic growth is a transformation following a traumatic event; it depicts positive change that goes above and beyond functioning before trauma (Meyerson, Grant, Carter and Kilmer, 2009). This growth is potentially seen in five different areas: changed perceptions of strength, interpersonal relationships, appreciation of life, new possibilities and spiritual change (1996). A core part of the growth process involves a struggle with one’s new reality in the aftermath of trauma, followed by constructive cognitive processing of the event that may change one’s perspective of the self, others, life and ways of living for the better (Cryder, Kilmer, Tedeschi & Calhoun, 2006). There is a great need to examine this phenomenon, and to learn ways to foster positive adaptation following trauma and stressful life events for everyone.
Post-traumatic growth can be conceptualized as either an outcome of trauma or an ongoing coping process. In Tedeschi and Calhoun’s “functional-descriptive model of PTG”, growth is solely an outcome. They describe the growth process, in which trauma shakes a person’s goals or world views and his or her ability to handle emotional distress, and the person then engages in behavior designed to reduce this distress. In their model, the individual engages in a process of rumination, which progresses from intrusive rumination (dwelling on the event) to deliberate rumination (finding meaning, re-appraisal), which may then lead to the development of post-traumatic growth (2004). “PTG is conceptualized as a multidimensional construct including changes in beliefs, goals, behaviors, and identity as well as the development of a life narrative and wisdom” (2006, p. 630).
Post-traumatic growth has also been seen as a coping strategy or process. For example, it can be seen as a component of a meaning-making coping process (2006). Park and Folkman (1997) describe a meaning making process which comprises of global meaning (one’s goals or beliefs) and situational meaning (an interaction between one’s global meaning and their current circumstances). The coping task would then be to reconcile the trauma appraisal (situational meaning) with global meaning (1997). Growth, then, can be seen when one finds benefits from the event (re-appraising the trauma to accommodate global meaning) or changing one’s global meaning, creating a new philosophy of life (2006). Post-traumatic growth has also been conceptualized as an interpretative process in which rumination, and understanding what happened and why, lead to a new interpretive reality, and this reality may be constructed from the perspective of growth (Filipp, 1999).
Post-traumatic growth has been studied most often in adults (Zoellner and Maercker, 2006). Although less is known about post-traumatic growth in children, evidence of post-traumatic growth among children as young as 6-years-old has been reported (Cryder et. al, 2006). Several factors related to cognitive style and coping efforts are associated with experiencing post-traumatic growth following traumatic events.
In adults, one cognitive factor that may lead to post-traumatic growth is optimism, in which individuals engage in problem-focused coping for controllable, stressful events and acceptance-based or emotion-focused coping for uncontrollable, stressful events. Further, openness to new experiences, as well as hardiness (curiosity about the world, embracing change as normal, feeling control over events) may also be linked to post-traumatic growth. In addition, searching for meaning as well as engaging in positive reappraisal may be crucial for this development. Positive re-appraisal describes positive interpretation coping, in which an individual may regularly make use of benefit-related information following traumatic events (2006). Religious coping as well as social support seeking coping are also associated with post-traumatic growth in adults (Prati & Pietrantoni, 2009).
Several factors are associated with the development of post-traumatic growth in children as well, though less is known about this phenomenon in youth. In terms of coping, active and avoidance coping may be linked to the development of post-traumatic growth, specifically the domains of new possibilities and personal strength. Avoidance coping involves denial, yet researchers suggest that this might be a part of processing the event which is “needed for growth to occur” (Wolchik et. al, 2009, p. 8). In addition, participation in an organized religion may be positively associated to post-traumatic growth (Milam et. al, 2004). Gratitude may be related to the development of growth in children, as well as deliberate rumination (Zhou & Wu, 2015). Finally, a systematic review of post-traumatic growth conducted by Meyerson, Grant, Carter and Kilmer (2011) identified several positive mental resources in children that may lead to post-traumatic growth: positive affect, hope, optimism, self-esteem, competency beliefs and higher quality of life.
In children, there are inconclusive findings regarding the relationship between demographic factors and post-traumatic growth. Some studies suggest older children are more susceptible to post-traumatic growth, while others suggest the opposite. There is also evidence to suggest posttraumatic growth occurs more in females, and contrasting evidence to suggest it occurs more in males. Studies have also demonstrated post-traumatic growth in European American samples, as well as Latino, African American and Persian samples. There is no evidence to support a relationship between socioeconomic status and post-traumatic growth in youth. Perhaps, demographic factors influencing the development of post-traumatic growth is situational, i.e., various groups of people may be more likely to grow depending on the type of trauma encountered. In adults, there is evidence that females, ethnic minorities and younger adults are more likely to experience post-traumatic growth (Meyerson et. al, 2009).
While post-traumatic growth might typically be seen in a positive light, it is important to note that in both adults and children, post-traumatic stress symptoms might also be positively related to post-traumatic growth (Zoellner and Maercker, 2006). One study in children suggests post-traumatic growth in children might be greatest when post-traumatic stress symptoms are moderate (Levine, Lauffer, Hamama-Raz, Stein & Solomon, 2008). Posttraumatic growth and posttraumatic stress disorder are thought to be independent constructs, not two different ends of the same continuum. Growth is distinct from emotional adjustment; thus, posttraumatic growth may co-occur with emotional distress (2006).
Overall, there is a fair amount of research to suggest cognitive and coping styles of individuals who are more likely to experience post-traumatic growth, and less research regarding specific groups of people who are more likely to experience of growth. In terms of explaining why or how post-traumatic growth happens, less is known. As Tedeschi and Calhoun (2004) discuss, the idea that suffering can be the source of positive change is not new, and prevalent in different teachings of many religions. Several ideas and beliefs about the world appear to allow some people to make meaning following traumatic events. A psychological crisis, like trauma, shakes many peoples’ assumptive world and may cause cognitive rebuilding. There is an affective component in understanding this crisis: people may value what happens in the aftermath while also experiencing the distress of trauma. Thus, post-traumatic growth might be a result of attempts of psychological survival (2004).
Given what we know about the experience of post-traumatic growth, there may be utility in understanding this phenomenon. Post-traumatic growth can be a core component in the healing process; acknowledgement of this phenomenon allows one to imagine the idea of growth following trauma. Indeed, psychologist Carol Dweck formulated the concept of growth versus fixed mindset (Dweck, 1999). Individuals who have adapted the “fixed mindset” believe that their character and abilities can not be changed. They believe their personality qualities and intelligence are inherent, carved in stone. On the other hand, individuals who have adopted the “growth mindset” believe that these qualities can be developed over time. These individuals tend to be more resilient, and learn from failure rather than dwell on it (Popova, 2014). Adopting the growth mindset can have positive consequences. For one, learning about the growth mindset can potentially reduce depressive symptoms in adolescents (Schleider & Weisz, 2017). Further, beliefs that one can change their emotions may lead to better use of emotion regulation strategies, and those who’ve adopted a growth mindset might be less likely to develop psychopathology following a history of stressful life events (De Castella et al., 2013; Shroder et. al, 2017). Overall, understanding that is possible to grow at all, but specifically from a traumatic event, may elicit positive adaptations within an individual.
Meaning-making may also play a role in healing with posttraumatic growth. Many individuals attempt to “[restore] meaning in the context of highly stressful events” (Park, 2010, p. 257). Individuals may appraise stressful events in various ways; these appraisals may either lead to distress or psychological well-being. For example, victims of sexual assault who appraised the assault with a negative impact on themselves, the world and others were more likely to develop PTSD symptoms. Further, those who appraise events as threatening or uncontrollable might be more likely to experience distress. Meaning-making involving non-judgement, in contrast with meanings of blame and negative evaluation, may lead to positive adjustment following stressful events (Park, 2010). When meaning-making is constructive and adaptive, it may lead to posttraumatic growth following trauma (Wang et. al, 2015).
Post-traumatic growth is not necessary to recover from trauma, rather, it is a potential trajectory of functioning. It is important not to downplay the experience of trauma, nor expect that individuals will grow in the aftermath. Many people suffer with varying levels of distress following trauma. However, people can be flexible in their process of recovery, and can be grateful when they experience growth, whether it be in specific domains (e.g., experiencing new possibilities, more appreciation for life) or in general.
Castella, Krista De, Philippe Goldin, Hooria Jazaieri, Michal Ziv, Carol S. Dweck, and James J. Gross. “Beliefs About Emotion: Links to Emotion Regulation, Well-Being, and Psychological Distress.” Basic and Applied Social Psychology 35, no. 6 (2013): 497–505. https://doi.org/10.1080/01973533.2013.840632.
Cryder, Cheryl H., Ryan P. Kilmer, Richard G. Tedeschi, and Lawrence G. Calhoun. “An Exploratory Study of Posttraumatic Growth in Children Following a Natural Disaster.” American Journal of Orthopsychiatry 76, no. 1 (2006): 65–69. https://doi.org/10.1037/0002-9418.104.22.168.
Dweck, Carol S. Self-Theories: Their Role in Motivation, Personality, and Development. Philadelphia etc.!: Psychology Press, 1999.
Filipp, S. H. (1999). A three-stage model of coping with loss and trauma. In A. Maercker, M. Schützwohl, & Z. Solomon (Eds.), Posttraumatic stress disorder: A lifespan developmental perspective (pp. 43−78). Seattle, WA: Hogrefe and Huber.
Kilmer, Ryan P., Virginia Gil-Rivas, Richard G. Tedeschi, Arnie Cann, Lawrence G. Calhoun, Teresa Buchanan, and Kanako Taku. “Use of the Revised Posttraumatic Growth Inventory for Children.” Journal of Traumatic Stress 22, no. 3 (2009): 248–53. https://doi.org/10.1002/jts.20410.
Levine, Stephen Z., Avital Laufer, Yaira Hamama-Raz, Einat Stein, and Zahava Solomon. “Posttraumatic Growth in Adolescence: Examining Its Components and Relationship with PTSD.” Journal of Traumatic Stress 21, no. 5 (2008): 492–96. https://doi.org/10.1002/jts.20361.
Meyerson, David A., Kathryn E. Grant, Jocelyn Smith Carter, and Ryan P. Kilmer. “Posttraumatic Growth among Children and Adolescents: A Systematic Review.” Clinical Psychology Review 31, no. 6 (June 13, 2011): 949–64. https://doi.org/10.1016/j.cpr.2011.06.003.
Milam, Joel E., Anamara Ritt-Olson, and Jennifer B. Unger. “Posttraumatic Growth among Adolescents.” Journal of Adolescent Research 19, no. 2 (2004): 192–204. https://doi.org/10.1177/0743558403258273.
Park, Crystal L., and Susan Folkman. “Meaning in the Context of Stress and Coping.” Review of General Psychology 1, no. 2 (1997): 115–44. https://doi.org/10.1037/1089-2622.214.171.124.
Park, Crystal L. “Making Sense of the Meaning Literature: An Integrative Review of Meaning Making and Its Effects on Adjustment to Stressful Life Events.” Psychological Bulletin 136, no. 2 (2010): 257–301. https://doi.org/10.1037/a0018301.
Prati, Gabriele, and Luca Pietrantoni. “Optimism, Social Support, and Coping Strategies As Factors Contributing to Posttraumatic Growth: A Meta-Analysis.” Journal of Loss and Trauma 14, no. 5 (2009): 364–88. https://doi.org/10.1080/15325020902724271.
Popova, Maria. “Fixed vs. Growth: The Two Basic Mindsets That Shape Our Lives.” Brain Pickings, February 16, 2020. https://www.brainpickings.org/2014/01/29/carol-dweck-mindset/.
Roepke, Ann Marie. “Psychosocial Interventions and Posttraumatic Growth: A Meta-Analysis.” Journal of Consulting and Clinical Psychology 83, no. 1 (2015): 129–42. https://doi.org/10.1037/a0036872.
Schleider, Jessica, and John Weisz. “A Single-Session Growth Mindset Intervention for Adolescent Anxiety and Depression: 9-Month Outcomes of a Randomized Trial.” Journal of Child Psychology and Psychiatry 59, no. 2 (2017): 160–70. https://doi.org/10.1111/jcpp.12811.
Schroder, Hans S., Matthew M. Yalch, Sindes Dawood, Courtney P. Callahan, M. Brent Donnellan, and Jason S. Moser. “Growth Mindset of Anxiety Buffers the Link between Stressful Life Events and Psychological Distress and Coping Strategies.” Personality and Individual Differences 110 (2017): 23–26. https://doi.org/10.1016/j.paid.2017.01.016.
Tedeschi, Richard G., and Lawrence G. Calhoun. “The Posttraumatic Growth Inventory: Measuring the Positive Legacy of Trauma.” Journal of Traumatic Stress 9, no. 3 (1996): 455–71. https://doi.org/10.1002/jts.2490090305.
Tedeschi, Richard G., and Lawrence G. Calhoun. “Posttraumatic Growth: Conceptual Foundations and Empirical Evidence.” Psychological Inquiry 15, no. 1 (2004): 1–18. https://doi.org/10.1207/s15327965pli1501_01.
Wang, Yu, Yiqun Gan, Miao Miao, Qin Ke, Wenju Li, Zijin Zhang, and Gang Cheng. “High-Level Construal Benefits, Meaning Making, and Posttraumatic Growth in Cancer Patients.” Palliative and Supportive Care 14, no. 5 (2015): 510–18. https://doi.org/10.1017/s1478951515001224.
Wolchik, Sharlene A., Stefany Coxe, Jenn Y. Tein, Irwin N. Sandler, and Tim S. Ayers. “Six-Year Longitudinal Predictors of Posttraumatic Growth in Parentally Bereaved Adolescents and Young Adults.” OMEGA – Journal of Death and Dying 58, no. 2 (2009): 107–28. https://doi.org/10.2190/om.58.2.b.
Zhou, Xiao, and Xinchun Wu. “Longitudinal Relationships between Gratitude, Deliberate Rumination, and Posttraumatic Growth in Adolescents Following the Wenchuan Earthquake in China.” Scandinavian Journal of Psychology 56, no. 5 (2015): 567–72. https://doi.org/10.1111/sjop.12237.
Zoellner, Tanja, and Andreas Maercker. “Posttraumatic Growth in Clinical Psychology — A Critical Review and Introduction of a Two Component Model.” Clinical Psychology Review 26, no. 5 (2006): 626–53. https://doi.org/10.1016/j.cpr.2006.01.008.