Post Traumatic Growth
By David Nixon, written for Bolton Trauma Informed Toolkit
“What doesn’t kill you makes you stronger.” (anon)
It is a popular phrase. It is a very muscular phrase, filled with bravado and poetry. Some people find comfort in this phrase, and in some cases it might be close to the truth. It is, perhaps, a simplification of a phenomenon we are only just starting to fully understand (Tedeschi & Calhoun, 1995). Not everyone who experiences trauma will find themselves strengthened (Psych. Today, 2023). Is being strong always good? What about adaptability, suppleness, vulnerability, insight, learning and growth? What do we mean by ‘stronger’ exactly?
Being stronger is perhaps more related to resilience; a person’s ability to ‘bounce back’ in the face of adversity. But this is not the same as growth (Collier, 2016). Post Traumatic Growth (PTG) is a non-linear process (Max, 2021), It is complex and sometimes chaotic. PTG can take place over many years, sometimes decades, so it should not be seen as some rapid self development tool. Also, PTG is not a ‘silver lining.’ Let us not forget that to experience post traumatic growth, you first need to go through the pain of the trauma. Certainly trauma and suffering can be a trigger for growth and the development of a new mindset, but it is not a given. Nor should it be seen as some kind of gift; it is hard won. People often talk about the metaphor of a phoenix representing a person rising out of trauma and adversity. However, what is mentioned less often is that the phoenix has to burn first.
According to the latest global epidemiological data, over 70.0% of people have been exposed to at least one traumatic event.
(Benjet et al., 2015)
Under the right conditions growth will occur. Just as with any natural growth process it is a matter of timing, nurture, environmental conditions, nourishment and, above all, time. This new growth will yield fruit in the form of improved relationships, new possibilities in life, increased personal strength, spiritual change, appreciation of life, being more in the moment, being present and open to new experiences. If we extend the metaphor, these fruit will provide the seeds for further growth in that person’s network. Perhaps this is the most powerful element of post traumatic growth: the potential for stimulating growth in others.
People experience growth in three distinct areas of life.
In themselves
Learning to control anger
Regulating trigger responses can take a great deal of time, especially when there are multiple triggers to manage and connections between those triggers.
For people who have experienced complex trauma and Adverse Childhood Events this can be particularly challenging. However, with the right support and guidance, and some effective personal practice one can master those emotions from which so many problems often arise.
Learning to overcome procrastination
Avoidance is a feature of trauma coping strategies. People can feel that they are not good enough, bound to fail, or be fearful of moving beyond what they feel to be a safe space.
Overcoming these restrictions is a powerful release from restrictive emotional states.
Learning to overcome inaction
The traumatised individual expends large amounts of energy managing their trauma. Through strategies such as energy management and energy conservation one can escape the trap of inaction which often leads to more depressive states.
Demonstrating greater empathy
Emotional and psychological trauma is an unseen condition. However, once one has been through it a greater depth of insight and understanding is achieved. We begin to see the pain that often sits behind what are framed as negative behaviours. We begin to empathise more and accept that there may be more to people’s behaviour than we can see on the surface.
Becoming a more responsible person
Learning the skills to integrate trauma into a ‘new normal’ that is free from damaging emotional states and responses takes personal commitment, discipline and sacrifice. It requires responsibility and courage to experience one’s pain.
Learning new things and developing new skills
Stepping into a bigger world where you fully understand the origins of your emotional and psychological pain is one of life’s highest achievements. Undertaking this journey demonstrates what is possible with commitment, guidance and resolve.
Changing your mindset and becoming more positive
Being positive takes effort. Going through recovery from trauma and making that full life reintegration results in great happiness and a sense of purpose and self worth. To move from a fixed to a growth mindset where trauma is a controlling force is an achievement to be proud of.
In their relationships
Communication
The foundation of any healthy relationship. Communicating your experiences, feelings and needs regarding trauma is challenging. Through this challenge communication skills are honed and refined.
Trust
People who have experienced trauma will often have trust issues and find it difficult to trust and/or feel that they can be trusted. Through good communication these barriers can be overcome with open and clear communication.
Respect
Trust establishes respect. In the trauma informed, respect is an almost sacred quality. It is recognition that one has suffered and fought hard to get back on their feet. It is a quality aligned with empathy.
Honesty
When we respect each other fully, we honour that with honesty. Honesty demonstrates both strength and vulnerability which both give depth and resonance to a healthy and strongly bonded relationship.
Affection
Affection will have deeper meaning. This is especially true where traumatic experience has involved physical or sexual abuse. To share affection is a demonstration of communication, trust, respect and honesty. Also, affection does not have to be romantic, it can be platonic, friendly. Touch is a quality often under-rated in healing from trauma. To those who have been isolated, affection is a powerful thing.
In their philosophy
Philosophy, in the classical sense, means a love of wisdom. It is also the discipline of seeking to understand the fundamental truths about ourselves, the world we live in and the universe of which we are a part (Cambridge, 2022). Going through any kind of trauma can expose one to challenges not easily met by mechanical thinking or standard clinical approaches. Developing a deeper philosophy, or even spirituality, provides us with a useful tool for understanding that which extends beyond the rational. Establishing a new personal philosophy realigns our interpretation of the universe and provides a new meaning to life (Metz, 2021).
There are five areas of PTG often experienced by those in recovery:
Relationships with others.
New possibilities in life.
Personal strength.
Spiritual change.
Appreciation of Life
Being more in the moment.
Being present and open to new experiences.
Through healing we have to open ourselves up to the pain we have experienced. At the time this can feel insurmountable, but as we come to terms with what has been felt, we find ourselves open to more than just pain.
We begin to find ourselves open to all kinds of positive emotions and experience. What is more, they do not have to be overwhelmingly positive. Just being open to just being is enough sometimes.
Relationships with Others
Post trauma, and post recovery, we find that we have more empathy for others. We might also be more sensitive to negative relationships and more adept at setting boundaries and communicating openly and honestly. We might find ourselves being more selective in relationships and allow them to develop more naturally rather than projecting expectations onto them.
New Possibilities in Life
You have overcome the seemingly impossible. You have faced fears and pain that you felt would kill you, and yet here you are, surviving and thriving. So what next? Perhaps a key piece of learning from trauma recovery is an appreciation of how long things can take and how small steps need to be. This equips a person with the right tools to take on bigger tasks.
Personal Strength
Just as the spinal consultant said, when in recovery people are working themselves hard. You develop emotional and psychological muscles that you never knew you had. You become stronger, more supple and more agile as a person.
Spiritual Change
You have been to a place where not everyone goes. You have faced darkness and stared into the burning jaws of oblivion and yet here you are. But the resonance of that experience will always be with you. Spirituality is our tool for living with the unknown. Spirituality is eternity in the face of impermanence. Spirituality and spiritual practice enable us to access those places which transcend language and thought and human understanding.
Appreciation of Life
Trauma can numb the self to the experience of living. With depressive states life can lose its meaning and we find ourselves self isolating and experience a depleted social life. Coming through this and stepping into the bigger world of post traumatic growth can be an almost euphoric experience. One recognises that life is not always about exhilaration and achieving high states of happiness, deep meaning and value can be found in moments of simply being. Peacefulness, stillness and harmony are all values that enhance our experience of life after coming through trauma and integrating the trauma into a new way of being.
Being More in the Moment
Trauma causes us to be fearful of the future and often the past is too painful to consider. We feel trapped in the moment that we are in, it is a prison of dissonant feelings, intrusive thoughts and physical discomfort. However, when we start to integrate our trauma we let the light in. The moment we are in becomes the one place where we can feel empowered and free. This is deep learning aligned with meditative enlightenment.
Being More Present & Open to New Experience
Being in the moment means that we are more present. We are clearer, less bound to our past and hindered by negative experience. Integrating our trauma into a new way of being and moving beyond the confines of the past opens us to all kinds of new opportunities. When we add all the other new growth to this we find ourselves in the perfect place to step out and seize the day.
Points to Consider
It has been highlighted that Post Traumatic Growth is a process which takes time, is complex and nonlinear. Also it is not a given. It is also a relatively new field of research, and as such there is still much work to be done. There are those who contest the validity of PTG (Mancini, 2016), and this is an important part of the process of building a solid evidence base. Secondly, something many people experience through personal growth is the loss of friendships; or ‘drifting’ (Dinner, 2019) apart from long standing friends. This is a natural part of growth but can sometimes feel painful or at least disruptive. Finally, there is the simple fact that PTG is not a given. It is not magic, silver lining type event which happens to everyone who experiences trauma. It takes time and the right conditions to take advantage of new insights
New beginnings are often disguised as painful endings
(Lao Tzu in van der Vloodt, 2017)
Creating the Right Environment
In a 2021 Healthline article some characteristics identified as being beneficial to the development of Post Traumatic Growth were:
A Strong Support System
A good support network should be a combination of professional, personal and practical. The boundaries between these ‘3Ps’ will overlap in terms of what they are providing and how they are providing it. Also, a support system should not ‘care’ for the individual as this will hinder their own process of growth. A good support network should adapt and move with the individual as they learn, grow and become stronger.
Family
Friends
Remote
Online
Research
peer networks
Charities
Partner
therapist/counselor
Financial support
GP
Allied Health Professionals (occupational therapy, physiotherapy, dietetics.)
Being Open to Change
This is subjective. Being open to change might mean working through a trauma in different ways, or re-experiencing traumatic pain. It can depend on personality type, resources and all kinds of factors. A person working toward growth will often know intuitively that now is the time to take greater control. Sometimes this is a gradual process, sometimes it can happen suddenly. The process of growth will be individual to each person. For this reason a client centered approach is critical. Value the language and respect the narrative at all times.
Timing
Confidence
Opportunities
Resources
Challenges
Readiness
The Ability to Integrate the Trauma
This will take time and it may be that the trauma is never fully integrated. However, the individual may find a place in their progress where they feel content. Here they can function and perform in such a way that growth, health and happiness are achieved. From this place further growth may occur.
Therapeutic progress
Insight
Acceptance
Knowledge
Developing New Belief Systems
Belief systems, like integration of experience, take time to develop. However, finding new perspectives can be supported by engaging with new people, reaching out to supportive groups and peer networks and expanding your own knowledge. It may be that you were not even aware of having a belief system, so for some knowing where you have come from might be a good place to start.
Networks
Wider reading
Access to relevant information
Actions
These are just a few ideas of actions to take to support post traumatic growth. This is not an exhaustive list, but gives an idea of how activities and occupations can be used to facilitate recovery and growth.
Adopt a reflective approach. Journalling is a useful way to track progress and make regular reflections on thoughts, feelings and behaviours. It is especially useful if you are engaged in regular counseling or therapy sessions. Keeping a journal means that you look back over how you felt that time, instead of trying to remember where you are now. This will give a clearer indication of your journey and provide you with a meaningful narrative.
Expressive arts and creativity engage us in new ways. We can allow ourselves to be free and reframe our experience through enjoyable activities. In Addition to the creation of content we can learn new skills and turn creative exploration into a social activity as well; sharing experiences and forging new, healthy relationships.
Horticulture has many therapeutic values. What better way to engage in a process of growth than by growing things. Growing is also scalable, from a single indoor plant to a full scale allotment. Growing involves physical activity, skill acquisition, it has a social element and the fruits of your labours may actually be fruit.
Peer support can be live or online. There are numerous support groups for people who have experienced trauma of some kind and wish to find strength in the company of others who have had similar experiences. Sharing in this way can help us integrate trauma into our lives and move forward to a place of new growth.
Learning can mean a number of things. It might mean simply learning more about your own experience, or it might mean retraining entirely. Whatever it means to you, fresh knowledge and new learning is never a bad thing. Using our minds to further ourselves provides us with new knowledge, new opportunities and helps us discover new potential in ourselves.
Although there is evidence that PTG can occur naturally without any intervention, this does not apply to everyone. Furthermore, having some strategies and tools to hand means that you can fully explore what is possible post trauma. Remember this is an emerging field and more research is needed, there will be negatives and challenges, but this does not mean we should turn our backs on the potential for people to not only recover from their experience, but to learn and grow from it and share that learning with others.
Post Traumatic Growth is not a straight line. It is not easily achieved and it is not guaranteed. However, if we give time, support exploration and curate trauma-informed environments, systems and relationships, we stand a better chance, for those who have lived with trauma, to find and achieve a whole new potential.
References
Akhtar, M. (2017) Post Traumatic Growth by Miriam Akhtar. 28 June. Available at: https://youtu.be/YYdnAeaxJ2Y?si=HzBiyBSYdrM-gQ-C (Accessed: 21 October 2023).
Benjet, C. et al. (2015) ‘The epidemiology of traumatic event exposure worldwide: Results from the World Mental Health Survey Consortium’, Psychological Medicine, 46(2), pp. 327–343. doi:10.1017/s0033291715001981.
Cambridge (2022) Philosophy, Cambridge Dictionary. Available at: https://dictionary.cambridge.org/dictionary/english/philosophy (Accessed: 21 October 2023).
Collier, L. (2016) Growth after trauma, Monitor on Psychology. Available at: https://www.apa.org/monitor/2016/11/growth-trauma (Accessed: 21 October 2023).
Dinner, K. (2019) How losing friendships can be a sign of growth, Medium. Available at: https://medium.com/jrni/how-losing-friendships-can-be-a-sign-of-growth-14ceff479892 (Accessed: 21 October 2023).
Mancini, A. (no date) The trouble with post-traumatic growth, Psychology Today. Available at: https://www.psychologytoday.com/gb/blog/rethinking-trauma/201606/the-trouble-post-traumatic-growth (Accessed: 21 October 2023).
Max (2021) Post traumatic growth – beyond just healing, British Society of Lifestyle Medicine. Available at: https://bslm.org.uk/post-traumatic-growth-beyond-just-healing/ (Accessed: 21 October 2023).
Metz, T. (2021) The meaning of life, Stanford Encyclopedia of Philosophy. Available at: https://plato.stanford.edu/entries/life-meaning/ (Accessed: 21 October 2023).
Nash, J. (2023) 23 post traumatic growth worksheets for therapy (+PDF), PositivePsychology.com. Available at: https://positivepsychology.com/post-traumatic-growth-worksheets/#worksheets-ptg (Accessed: 21 October 2023).
Psychology Today (no date) Post-traumatic growth, Psychology Today. Available at: https://www.psychologytoday.com/gb/basics/post-traumatic-growth (Accessed: 21 October 2023).
Sasson, R. (2023) What is personal growth and Why you need it, Success Consciousness | Positive Thinking - Personal Development. Available at: https://www.successconsciousness.com/blog/personal-development/what-is-personal-growth/ (Accessed: 21 October 2023).
Tedeschi, R. and Calhoun, L. (1995) ‘Trauma & transformation: Growing in the aftermath of suffering’, Sage Publications, Inc. 10.4135/9781483326931 [Preprint]. doi:10.4135/9781483326931.
van der Vloodt, R. (no date) #WHATIS post-traumatic growth, the journey from adversity to growth by ..., www.ptsdresolution.org. Available at: https://ptsdresolution.org/pdf/WHATIS%20PTG%20REVIEW.pdf (Accessed: 21 October 2023).
Zola, M. (2022) 5 signs of a healthy relationship, Eugene Therapy. Available at: https://eugenetherapy.com/article/5-signs-of-a-healthy-relationship/ (Accessed: 21 October 2023).
