Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
FROM SURVIVING TO
THRIVING:
A COMPARISON OF RESILIENCE
THEORY AND POST-TRAUMATIC
GROWTH
Nicole Simonson, EdS, LPC, NCC
Introduction
The literature on trauma has predominantly focused on the negative outcomes of traumatic events
More recently, a call towards incorporating each of the negative and positive outcomes has emerged.
“That which does not kill us makes us stronger.”
-Friedrich Nietzsche
What is Post-Traumatic Growth?
What is Post-Traumatic Growth (PTG)?
Term, “Post-Traumatic growth” (PTG) / coined in 1995 by Richard Tedeschi and Lawrence Calhoun-
“ Positive psychological change that occurs as the result of one’s struggle with a highly challenging, stressful, traumatic event.”
Positive psychological or life change that occurs as a result of traumatic events
Involves a movement beyond pre-trauma levels of adaptation
Develops as a result of lessons learned from exposure to trauma or crisis
Post-Traumatic growth is an ongoing process
Synonyms= Stress-related growth and benefit-finding
Post-Traumatic Growth and History
The general understanding that suffering and distress can potentially yield positive change is thousands of years old
Theme was present in ancient spiritual and religious (Judaism, Buddhism, Christianity) traditions, literature and philosophy
Scholarly interest in post-traumatic growth increased in the 1990s- given a scientific name
Emphasis was placed on studying individuals who face a wide variety of difficult circumstances experience significant changes in their lives - many of which are positive
Factors that affect PTG:
Age (older)
Gender (female)
Severity and type of stressor/trauma
Higher income
More time since traumatic event
Existential awareness (life’s fragility)
Religiosity
Higher levels of social support
Measurement of PTG
Five self-report measures to assess growth as a multidimensional construct have been developed and validated:
1. Changes in Outlook Questionnaire
2. Stress Related Growth Scale
3. Perceived Benefit Scale
4. Thriving Scale
5. Posttraumatic Growth Inventory
PTG Inventory
The Post-traumatic Growth Inventory (PTGI) is the standardized inventory most often used to measure growth that follows a traumatic life event.
It is a 21-item self-report inventory that uses a six-point Likert scale to measure positive outcomes that result from traumatic experiences.
E.g. Likert- 0-5 1. My priorities about what is important in life
2. An appreciation for the value of my own life
3. I developed new interests
4. A feeling of self-reliance
5. A better understanding of spiritual matters
In addition to an overall scale score, the PTGI comprises five factors:
Relating to others
New possibilities
Personal strength
Spiritual change
Appreciation for life
5 - Domains to PTGI
Post-Traumatic Growth
Personal Strength
Explore New Life Possibilities
Form Meaningful Interpersonal Relationships
Gain Appreciation for Life
Develop Spirituality
General Paradox-
Where there is loss, there is gain.
Domains of PTG:
1. Increased Personal Strength
-Recognition of more capabilities to deal with future challenges and adversities, and even to change situations that need to be changed.
-The subject clearly distinguishes that after the event he/she is a person with more skills and strengths, compared to the self before the trauma occurred.
-However, this greater sense of personal strength is accompanied by the perception of individual vulnerability, and by a clear understanding of the negative impact of traumatic events in one’s life.
-Recognition of possession of strength
“After going through this, I can handle anything!”
Characteristics of perceived changes in self:
Becoming stronger
More confident
New awareness of an authentic self
A ‘better self’
Deeper
More open
More empathetic
More creative
More alive
More mature
More humanitarian
More special
More humble
Domains of PTG:
2. New Possibilities/Change in Priorities
-The creation of a new life path is related
with a perception of a new philosophy of life that changes the past assumptions and core beliefs leading to new possibilities and opportunities that did not exist before the trauma.
-Taking a new path in life “Maybe I can help someone who’s gone
through this?”
Domains of PTG:
Characteristics of Changed Priorities:
How and with whom they decided to spend their day
Appearance
Nature
Monetary goods
Health
New appreciation of life (calling it a ‘gift’)
The ‘here and now’
Simple things
Time
Change life goals
Learn new skills
Go back to school
Domains of PTG:
3. Meaningful Relationships
-In dealing with the stress and loss, he/she might look for support
from family and friends.
-Increased self-disclosure= a perceived higher emotional connection in
interpersonal relationships
-Accepts the support given by others and make
better use of already existing social networks or invest in new ones
-Some relationships may become more meaningful, while others may
be weakened or even end
-New perspectives in relationships
“I cherish my family a lot more.”
Characteristics: Closer relationships with family/friends Neighbours Fellow trauma survivors Strangers Increased appreciation for significant others “True friends are”
Domains of PTGI:
4. Increased Appreciation for Life
As a result of the cognitive reconstruction, the subject has a
sense of vulnerability and recognizes he/she cannot predict or control certain events
Greater appreciation of life itself
Subject begins to pay attention to small things that were previously considered insignificant or unimportant, resulting in a change of life priorities and a greater appreciation of life.
Subject has a changed sense of what is important=
“I appreciate the smaller things in life.”
Domains of PTG:
5. Spiritual Development As a result of individual strength in confrontation with the
stressful conditions, the trauma survivors’ experiences are, in some way, an opening to religious questions or a perception of growth regarding religious or spiritual matters
Reflection of mortality
Changed worldview
Meaning and purpose in life
Finding reasons/making meaning from the trauma
‘Vulnerability’ and ‘the shortness of time’
“God carried me through it.”
Domains of PTG:
Characteristics of Enhanced Spiritual Beliefs:
Increased spirituality
Return to faith
Spiritual practices
Praying
Attending church
Gratitude to God
Strengthening of faith
Bereavement
Can be used as a coping mechanisms or as an outcome
Importance and existence differs across culture
Caveat
Don’t have to have all 5 domains to have experienced growth
May be in existence with distress
Current 5 domains may not include all aspects of growth
“The world breaks everyone and afterward many are strong at the broken places.”
-Ernest Hemingway
What is Resiliency?
Resilience Theory
An individual’s capacity to withstand stressors and not manifest psychological dysfunction.
Resiliency is the process of adapting well in the face of: Adversity
Trauma
Tragedy
Threats
Significant Sources of Stress: ‒ Family & relationship problems
‒ Serious Health Problems
‒ Workplace stress
‒ Financial Stress
Studies show that the primary factor in resilience is having caring and supportive relationships within and outside the family.
Resilience Theory
Ability to recover readily after life’s hardships
“Toughing through it.”
It’s possible that some people may be more biologically predisposed toward being resilient; but psychological and environmental factors can contribute to its development.
The good news is that resilience is not a trait that people either have or do not have – it involves thoughts, beliefs, attitudes and behaviors that can be learned and developed.
Several additional factors are associated with resilience, including: The capacity to make realistic plans and take steps to carry them out
A positive view of yourself and confidence in your strengths and abilities
Skills in communication and problem solving
The capacity to manage strong feelings and impulses
Risk and Protective factors
Risk/stress factor: A condition that increases the probability of a disorder (e.g., abuse, neglect, violence exposure, poor health care).
Protective factor: A condition that inhibits, reduces, or buffers the probability of a disorder (e.g., parental monitoring, problem-solving skills, school connectedness).
Individual risk factors
Impulsivity
Aggressive/violent behavior
Low Intelligence
Disregard for others
Sensation seeking
Language problems
Poor interpersonal boundaries
Disconnected from school/unemployed
Substance Abuse
Low self-esteem
Prenatal exposure to drugs/alcohol
Poor/irregular attachment
Unsatisfactory relationships
Biological risk factors (head injury, infection, nutrition, exposure to toxins)
Acute health condition
Family risk factors
Family history of mental illness
Parental crime/incarceration
Familial abuse/neglect
Familial substance abuse
Lack of parental support
Family isolation
Large family size
Death of a caregiver
Physical/mental illness of a loved one
Individual protective factors
Social
Competence Autonomy
Sense
of
Purpose
Problem
Solving
Responsiveness
Communication
Empathy/ Caring
Compassion Altruism
Forgiveness
Planning
Flexibility
Resourcefulness
Critical Thinking
Insight
Goal Directed Achievement
Motivation
Optimism/
Hopefulness
Faith/ Spirituality
Sense of Meaning
Positive Identity
Internal Locus
of control
Self-efficacy Mastery
Adaptive
Self-Awareness
Humor
Key Characteristics of Resilience
Locus of Control
A personality trait which can affect resilience levels.
Developed by Julian Rotter in 1954: The extent to which individuals believe they
can control events which affect them. OR
The control individuals feel they have over the environment around them.
Everyone sits on a continuum between having an internal
or external locus of control.
Locus of Control
• Enjoyment • Interest • Self Esteem • Sense of achievement • Desire to win
• Salary/bonuses • Job security • Approval/praise/pleasing others • Promotion • A prize
INTERNAL
EXTERNAL
PTG vs. Resilience
In contrast to resilience:
PTG refers to a change in people going beyond an ability
to resist and not be damaged by highly stressful circumstances
Involves a movement beyond pre-trauma levels of adaptation
Subjects with PTG have coping strategies that allow them to be less challenged by trauma
The struggle with trauma may be crucial for posttraumatic growth, not trauma itself
PTG vs. Resilience
Resilience in children exists prior to exposure to trauma or a stressful life experience.
Resilient individuals have a high level of coping after trauma.
Post-traumatic Growth in children develops as a result of lessons learned from exposure to trauma or crisis.
Post-traumatic growth is manifested in several clearly defined behaviors and thought patterns not necessarily present prior to exposure.
PTG vs. Resilience
The following factors are associated with resilience in children:
Above average communication skills, cognitive abilities, and problem-solving abilities
Positive beliefs about self and future talents, hobbies, and/or special skills
Ability to self-regulate behavior
Able to ask for help from adults
Stable, nurturing parent or caretaker and extended family
Supportive, positive school experiences
Consistent family environment such as family traditions, rituals, and/or structured routines
Strong cultural connections and cultural identity
What is my part?
Clinical Implications for Resilience and PTG
Three facets of Resilience
Recovery Stressor disrupts a person’s normal state of functioning
When stressor passes, person resumes her normal pre-stressor level of functioning
Resistance People who exhibit normal functioning before, during,
and after a stressor (even long after a stressor)
Reconfiguration Individuals reconfigure their cognitions, beliefs, and
behaviors in manner that allows them to adapt to traumatic experiences
Possibly withstanding future trauma
PTG in Clinical Practice
A more inclusive framework for treating stress response
Not a new “SCHOOL OR MODALITY” of therapy
Can be combined with any school of thought
Not a new “TECHNIQUE”
Works best with cognitive, narrative and existential approaches
Expert Companion
Clinician as expert companion Facilitator of PTG process
Not direct Not called a therapist
Open to being changed
Walks a step behind the client guiding the client
Patience and Trust
Without companionship, expertise is hollow
Downplay expertise
Stories need to be told, and experiences need to be understood--takes time and good listening
Model of Post-Traumatic Growth
Traumatic event distress shattering of
basic beliefs Automatic rumination and intrusions Active cognitive processing event New, adaptive assumptions Opportunities to find new meaning in
traumatic event to achieve PTG
PTG Model Elements
The person pre – trauma
Characteristics of trauma survivor
Assessment of client’s strengths
“How have you handled stress in your life prior to the trauma?”
Old crises can also provide a fruitful source for recognizing growth that the individual has already experienced.
Help the client construct a new set of beliefs about self using the evidence of adaptive coping with trauma.
“I’ve noticed something in you that you tend to overlook in yourself.”
PTG Model Elements:
Seismic Event Trauma as an Adaptation Process
Focus is on the aftermath of traumatic event
Difference in PTG and Trauma-focused therapy is in Trauma-Focused therapy, will spend more time on the trauma itself.
Redirect to what is happening after the trauma.
How are you doing in life? Where are you looking for your strengths? Things to incorporate in life?
Will not try to keep you in the traumatic moments.
PTG Model Elements
Rumination and Cognitive Elements
Brooding rumination versus reflective rumination
Expert companion establishes safety, listens carefully, encourages disclosure, avoids platitudes, and tolerates distress in survivor
Guides client through cognitive processing
Helps client get unstuck by proposing a new angle of the event by asking questions of its meaning and purpose
Therapeutic advice for clinicians:
Become the expert companion
Learn from the client
Do not engage in direct attempts to foster growth
Must be aware of growth themes
Listen for themes
Acknowledge themes in the clients own words
Arise as result with struggle, not as result of events only
Do not deny distress
If no signs of delusion, go with the clients understanding (positive illusions or not)
Do not solely use it as the sign of good intervention
Remember- not universal
Tolerance: Cultural and individual
considerations
Respect and work within the trauma survivor’s framework.
Tolerate “positive illusions.” Don’t underestimate people’s capabilities
Be willing to explore spiritual or religious views.
PTG and Mental Health
Negative relationship with depression and anxiety
Reduced alcohol and substance abuse Lower levels of general and emotional
distress Positively correlated with hope, optimism
and positive affect Enhanced Quality of life (Qol)
PTG and Physical Health
Lower cortisol levels
Greater immune system functioning among HIV patients with higher
levels of PTG
High PTG scorers, with hepatoma, survived 186 days longer than their
lower scoring peers
Less AIDS related mortality with self-reported benefit finding among HIV
positive men who had recently had someone close to them die of AIDS
Positive psychology may be running before it can walk in applications to
cancer care
Questions/Answers?
References
Armour, M. (2007). Violent Death. Journal of Human Behavior in the Social Environment, 14(4), 53-90.
Brokenleg, M. (2012). Transforming Cultural Trauma into Resilience. Reclaiming Children And Youth, 21(3), 9-13.
Betancourt, T. S., & Khan, K. T. (2008). The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Psychiatry, 20(3), 317-328.
Cloitre, M., Martin, N., & Linares, O. (2005). Children's resilience in the face of trauma. New York, NY: University Child Study Center.
Goodman, R. D. (2013). The transgenerational trauma and resilience genogram. Counseling Psychology Quarterly, 26(3/4), 386-405. doi:10.1080/09515070.2013.820172
Johnson, S. F., & Boals, A. (2015). Refining our ability to measure posttraumatic growth. Psychological Trauma: Theory, Research, Practice, And Policy, 7(5), 422-429. doi:10.1037/tra0000013
References
Joseph, S., Murphy, D., & Regel, S. (2012). An Affective-Cognitive Processing Model of Post-Traumatic Growth. Clinical Psychology & Psychotherapy, 19(4), 316-325. doi:10.1002/cpp.1798
Levine, S. Z., Laufer, A., Stein, E., Hamama-Raz, Y., & Solomon, Z. (2009). Examining the relationship between resilience and posttraumatic growth. Journal Of Traumatic Stress, 22(4), 282-286.
Lyon, C., & Parkins, J. R. (2013). Toward a Social Theory of Resilience: Social Systems, Cultural Systems, and Collective Action in Transitioning Forest-Based Communities. Rural Sociology, 78(4), 528-549. doi:10.1111/ruso.12018
McElheran, M., Briscoe-Smith, A., Khaylis, A., Westrup, D., Hayward, C., & Gore-Felton, C. (2012). A conceptual model of post-traumatic growth among children and adolescents in the aftermath of sexual abuse. Counselling Psychology Quarterly, 25(1), 73-82. doi:10.1080/09515070.2012.665225
References
Pack, M. (2014). Vicarious resilience: A multilayered model of stress and trauma. Affilia: Journal Of Women & Social Work, 29(1), 18-29. doi:10.1177/0886109913510088
Svetina, M. (2014). Resilience in the context of Erikson's theory of human development. Current Psychology, 33(3), 393-404. doi:10.1007/s12144-014-9218-5
Taormina, R. J. (2015). Adult Personal Resilience: A New Theory, New Measure, and Practical Implications. Psychological Thought,8(1), 35-46. doi:10.5964/psyct.v8i1.126
Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the Positive Legacy of Trauma. Journal Of Traumatic Stress, 9(3), 455-471.
Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychological Inquiry, 15(1), 1-18.
Wade, A. (1997). Small Acts of Living: Everyday Resistance to Violence and Other Forms of Oppression. Contemporary Family Therapy: An International Journal, 19(1), 23.