By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
How are PTSD, PTG, and Resilience related?
Is some sort of personal growth possible as a result of living through a traumatic experience? Recently researchers have begun to study the concept of Posttraumatic Growth (PTG.) There has always been a body of literature about how some difficulty might spur changes in a person and lead to a new way of seeing life. But could something that was so severe a stressor as to be traumatic really lead to positive growth? And if that change might happen, why? What characteristics of the person, the treatment they received, or their support system might transform Posttraumatic Stress into Posttraumatic Growth?
Zoellner & Maercker defined PTG as “the subjective experience of positive psychological change reported by an individual as a result of the struggle with trauma.” So far studies of PTG have been lacking and those that have taken place include mostly groups of people who are different from the clients we see in therapy who have PTSD. For example, many patients with PTSD also have co-occurring substance abuse disorders. Most studies of PTG have excluded clients with substance use disorders. We know from many individual reports that overcoming substance abuse especially in clients with PTSD can result in the client developing a new way of seeing the world and many in recovery report that they have grown as a result. Clients with suicidal thoughts have also been excluded from studies of PTG despite the recurrence of clients telling us that being hospitalized for a mental illness, especially with suicidal thoughts, can be a life-altering experience.
Hagenaars & van Minnen (Journal of Traumatic Stress, Vol. 23, No. 4, August 2010, pp. 504–508 (c 2010), conducted a study using Exposure Therapy. The therapy included steps beginning with low-intensity experiences such as “Patients were asked to close their eyes and talk about the traumatic event in the first person and in the present tense, recollecting as many sensory details as vividly as possible, i.e., as if the trauma was happening “here and now.” The intensity progressed to real-life situations. This procedure is similar to systematic desensitization procedures in use for specific phobias.
So what did they find? The more PTG the less PTSD and vice versa. Also, the more someone was “emotionally numb” the less likely they were to benefit from the treatment, and the less likely they were to have PTG. They concluded that an inability to feel emotions is related to an inability to grow. So the ability to face problems leads to growth and the inability to face problems leads to staying stuck in the problem. Unfortunately, this leads us around in a circle to the place we started. Resilient people can grow as a result of trauma but trauma can make you less resilient especially repeated traumas.
Some clients who have been forced to relive traumatic events become re-traumatized. So sometimes the exposure techniques make you better but the same treatment can also make you sicker. How do you choose? Clients who share about trauma in a safe environment seem to get positive benefits; those who are cross-examined for details get worse. So, in the end, the value or damage of the technique depends on the relationship. This is one reason that group counseling is so appealing. People with similar traumas feel safer in talking about them in a group that has had a similar experience. Counselors who are seen as accepting help and rejecting professionals harm. It is in the case of PTSD as in other therapy – all about the relationship.
One further problem with the concept of PTG, how do we know it happens? Mostly we measure it by the client’s subjective report. They say they grew as a result of the trauma so that is evidence. But how did they grow? Did they take new actions or did they have a change of attitude? Maybe both? People who are spurred to action appear to grow more.
We also suspect that PTG is related to resilience. So do resilient people have more growth as a result of a traumatic event or do people who overcome a traumatic event become more resilient?
We know that PTG reduces PTSD symptoms and that the process of growth is related to resilience somehow. It is also clear that there is a lot more PTSD out there than we wanted to recognize. The challenge is making use of the things we learn in research and theory to help the clients who walk in the door in their journey from Posttraumatic Stress Disorder (PTSD) to Posttraumatic Growth (PTG.)
Do any of you have experiences with Posttraumatic Stress Disorder (PTSD) or Posttraumatic Growth (PTG) you would care to share?
This post was featured in “Best of Blog – May 2012”
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