Researchers study idea that trauma, grief can beget strength

08/16/2011 12:00 AM

08/08/2014 10:05 AM

Psychologists call post-traumatic growth (PTG) the lesser-known sibling of post-traumatic stress disorder. The more dramatic PTSD has gotten far more publicity, and a cadre of researchers has been studying the positive side of trauma and grief: that most people bounce back to baseline, and some emerge from disaster stronger and better, at least in some ways.

Psychologists are squabbling about how to measure growth and foster it and whether that is a good thing.

In research prompted by talks at the University of Pennsylvania's Positive Psychology Center, the Army is looking for growth in soldiers who have been to battle. The National Cancer Institute's Office of Cancer Survivorship has made studying post-traumatic growth a priority.

Researchers at a recent meeting in Philadelphia of the International Positive Psychology Association reported growth in grandparents of disabled children and in new mothers.

Richard Tedeschi, who with research partner Lawrence Calhoun coined the term in 1995, concedes that the idea that pain can beget strength is hardly revelatory. Still, he said, growth, benefit-finding, wisdom, transformation, whatever you call it, is a "core aspect of human experience" worthy of study.

"This is ancient," said Tedeschi, who, like Calhoun, teaches at the University of North Carolina at Charlotte.

"This is what all religion is based on: how you deal with suffering. ... It's just that psychology for one reason or another didn't want to deal with it and found it suspect."

Some psychologists still do, saying many people who think they have grown probably have not. And many, who may be better in some ways, still feel lousy overall.

Even skeptics who think resilience — returning to baseline — is the norm also believe some people really do learn and grow from ordeals.

"There are people who sort of benefit from being tested in life," said Lawrence Cohen, a University of Delaware psychologist. Cohen, who was among the first to study PTG, now looks at how people react to smaller daily setbacks.

Studies from Drexel University and Children's Hospital of Philadelphia found post-traumatic growth among adolescent cancer survivors and their parents and among African-American teens whose parents had cancer.

Tedeschi and Calhoun were initially interested in wisdom and how people react to crisis. They interviewed the "stars" of rehabilitation centers and bereaved women.

"We were sort of surprised by the themes that kept coming up that the grief experience had, in some ways, forced them to become different people and ... that the new person was better than the old one," Calhoun said.

When one rehab patient said that "the accident that put me in the wheelchair was the best thing that ever happened to me," they thought he was in denial.

But they were curious enough to study the phenomenon they called "perceived benefit" and to develop the Posttraumatic Growth Inventory. It asks patients about their strength, sense of new possibilities, relationships with others, spirituality and appreciation for life.

Depending on the trauma, 30 to 90 percent see improvement, Calhoun said.

What exactly is a trauma? Everyone agrees that it's traumatic to watch a tornado destroy your town or a bomb kill your Army buddy. If someone says an event divided his life into before and after, that's probably a trauma for him, Tedeschi said.

But it can be quirky.

"I got a guy I worked with who's got terminal cancer who tells me it's not traumatic for him," he said. "What was traumatic was his divorce."

For growth to occur, crises need to be bad enough to shake one's world, but not awful enough to shatter it.

What separates people who grow from those who do not? The best predictor of either PTSD or growth is mental health before the trauma. As Christopher Peterson, a University of Michigan positive-psychology researcher, put it, "The rich get richer."

Being an optimist, Tedeschi said, helps a little. Avoiding your problems might get you to resilience, but you're more likely to grow if you confront them. Brooding about why this happened to you doesn't help, but more deliberative thinking about what comes next leads to growth.

James Coyne, a Penn psychologist who has studied cancer patients, said he thinks some people grow, but not as many as think they do.

"Sometimes, having that illusion is a way of keeping going," he said, "and I certainly don't want to interfere with that."

Asians often are confused, he said, by the Western interest in finding growth and benefit in bad things. "What about acceptance?" they ask.

George Bonanno, a Columbia University psychologist who studies resilience in the bereaved, is also skeptical.

"Most people that go through these events get over them," he said. "They don't particularly think about them a lot, and they don't grow, either."

A group of factors — financial security; supportive relationships; and being older, intelligent and good at finding the humor in situations — helps with resilience.

A key quality, Bonanno said, is "expressive flexibility," or using a variety of emotional skills. Some people think it's good to express emotion and bad to suppress it. What really matters "is not which coping behavior you use, but the flexibility to use the kind that is necessary."

One take-home message is that people are tougher than we may think.

"What comes out of all of this research ... is that, as a species, we deal really well with stress," said Carolyn Aldwin, an Oregon State University adult-development expert.

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