What is Posttraumatic Growth?

While the limited research and literature on suicide bereavement has focused on the psychopathology associated with this experience of loss, a new area of Positive Psychology offers another vehicle for investigating the possibilities of personal growth within the context of this distressing and traumatic event. Calhoun and Tedeschi (2006) pioneered the concept of Posttraumatic Growth (PTG), a construct of positive psychological change that occurs as the result of one’s struggle with a highly challenging, stressful, and traumatic event. This growth is measured by the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996), a 21-item instrument for assessing positive outcomes in people who have experienced traumatic events. Five domains or factors are contained within the larger construct of PTG and are measured on subscales within the PTGI. The five factors include Relating to Others (greater intimacy and compassion for others), New Possibilities (new roles and new people), Personal Strength (feeling personally stronger), Spiritual Change (being more connected spiritually), and a deeper Appreciation of Life (Tedeschi & Calhoun, 2004).

Many agree that growth in the midst of crisis is possible, but not necessarily likely (Tedeschi & Calhoun, 2004). What increases the likelihood is one’s cognitive engagement with the traumatic event in its aftermath or one’s ability to reflectively engage or “ruminate” over elements of the event in order to repair and restructure one’s understanding of the world (Calhoun & Tedeschi, 2006). Rumination is defined by Nolen-Hoeksema (2004, p.107) as “persistent thoughts about one’s symptoms of distress and the possible causes and consequences of those symptoms” and is a construct closely associated and predictive of depressive symptoms and dysphoria (Nolen-Hoeksema & Morrow, 1991; Nolen-Hoeksema, 2000; Nolan, Roberts, & Gottlib, 1998). Tedeschi and Calhoun adopt Martin and Tesser’s (1996) definition of rumination as thinking that revolves around resolving discrepancies and making sense of one’s previous goals and self and one’s current reality (Calhoun & Tedeschi, 2006). While the term “rumination” has acquired a negative connotation within the confines of social and behavioral research due to its association with depression (Calhoun & Tedeschi, 2006), posttraumatic growth theory uses this more neutral definition to define the function of rumination. It also distinguishes between an earlier more intrusive, involuntary, “brooding” style of rumination and a later, more deliberate, “reflective” rumination that is associated with posttraumatic growth. While the first kind of rumination may be associated with early sense-making of an untoward event, the second kind of rumination may be conceptualized as a form of cognitive processing in the aftermath of a crisis that leads to recognition that changes experienced are deeply profound and building of a kind of wisdom.

Posttraumatic growth theory does not suggest that there is an absence of suffering as wisdom builds, but rather that appreciable growth occurs within the context of pain and loss. In fact, some measure of significant distress may be necessary for growth to occur, although too much distress may impair the bereaved and render them unable to engage in the growth process (Butler et al., 2005). Research has demonstrated that higher PTGI scores are correlated with Posttraumatic Stress Disorder (Solomon & Dekel, 2007), suggesting that the disruption caused by the trauma is significant enough to create psychiatric symptoms and “shattering” enough to  their “assumptive world view” (Janoff-Bulman, 1992) to generate growth. 

Along with growth or wisdom-building, the fruits of PTG may also include a preparedness or “resilience” for future events that may otherwise be traumatic (Calhoun & Tedeschi, 2006; Meichenbaum, 2006). George Bonanno, whose research has been instrumental in challenging our assumption that the bereaved necessarily moves through “stages” of grief, has characterized resilience as an adaptive process that occurs in the wake of a traumatic event, such as the suicide of a loved one, to be able to maintain “healthy levels of psychological and physiological functioning . . . as well as the capacity for generative experiences and positive emotions” (2004, pp. 20-21).  Some researchers speculate that PTG is a kind of resilience, while others suggest that resilience plays an important role in the development of PTG (Lepore and Revenson, 2006). Calhoun and Tedeschi conceptualize a complicated relationship between PTG and resilience. Studies have shown an inverse relationship between PTG and resilience where highly resilient people experience less PTG than less resilient people do (Tedeschi & McNally, 2011). Highly resilient individuals may have stronger coping skills and are less likely to struggle with the psychological consequences of trauma, but are also less likely to experience as many opportunities for change that proceed from the emotional wrestling with trauma.

What makes growth more likely in some individuals and less likely in others?  Personality traits and mood states, such as extraversion, optimism, positive affect, openness to experience have been positively associated with PTG, while personality traits, such as neuroticism, have been negatively associated with PTG (Linley & Joseph, 2004; Stanton, Bower, & Low, 2006; Costa & McCrae, 1985). Other demographic variables, including gender and socioeconomic status, are also associated with this process (Calhoun & Tedeschi, 2006).  These characteristics may play a central role in how an individual manages the interruption of one’s life goals or plans through a personal crisis or a trauma (Tedeschi & Calhoun, 2004).