“I think as parents we’re always looking for those moments, and it’s not so much about, you know, teaching your kid ‘You have to be to be happy all the time.’ I know my legacy, I want them to able to find good out of an unhappy situation. My daughter and I were planting… I have a photo of it…. We were planting a little garden and she says like, ‘What’s that smell?’ and I said, ‘Well, the soil has manure in it. It stinks. It has poo in it.’ And she’s like, ‘That’s disgusting!’ And I said, ‘Well, let this be a lesson that really beautiful things can come from a stinky situation, sweetie. Because life’s not always going to give you roses. Sometimes it just gives you a pile of manure. But you plant seeds in it, and something beautiful can come out of it.’ ” ~ The View‘s Co-Host Paula Faris
Following two previous posts about Deviance, I wanted to change gears, and in doing so, decided to address something about more uplifting: Resilience. What Co-Host Paula Faris says in this video of The View definitely constitutes just that. But what is Resilience? According to the American Psychological Association:
Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors. It means “bouncing back” from difficult experiences.
Research has shown that resilience is ordinary, not extraordinary. People commonly demonstrate resilience. One example is the response of many Americans to the September 11, 2001 terrorist attacks and individuals’ efforts to rebuild their lives.
Being resilient does not mean that a person doesn’t experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress.
Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned and developed in anyone.
Factors in Resilience
A combination of factors contributes to resilience. Many studies show that the primary factor in resilience is having caring and supportive relationships within and outside the family. Relationships that create love and trust, provide role models and offer encouragement and reassurance help bolster a person’s resilience.
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.
All of these are factors that people can develop in themselves.
Strategies For Building Resilience
Developing resilience is a personal journey. People do not all react the same to traumatic and stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies.
Some variation may reflect cultural differences. A person’s culture might have an impact on how he or she communicates feelings and deals with adversity — for example, whether and how a person connects with significant others, including extended family members and community resources. With growing cultural diversity, the public has greater access to a number of different approaches to building resilience.
Some or many of the ways to build resilience in the following pages may be appropriate to consider in developing your personal strategy.
One method of developing resilience is utilizing coping skills. So just what are coping skills? According to Mental Health Wellness Week:
According to Sydney Youngerman-Cole, RN, BSN, RNC and Katy E. Magee, MA, “Many mental health problems begin when physical stress or emotional stress triggers chemical changes in your brain. The goal of treatment and prevention is to reduce stress and restore normal chemical processes in your brian.” Coping skills are methods a person uses to deal with stressful situations. Obtaining and maintaining good coping skills does take practice. However utilizing these skills becomes easier over time. Most importantly, good coping skills make for good mental health wellness.
Some good coping skills include:
- Meditation and Relaxation Techniques: Practicing deep breathing techniques, the relaxation response, or progressive muscle relaxation are ways to help reduce stress and induce relaxation.
- Time to Yourself: It is important to set aside time everyday to allow yourself to relax and escape the stress of life. Give yourself a private, mini vacation from everything going on around you.
- Physical Activity: Moving around and getting the heart rate up causes the body to release endorphins (the body’s feel good hormones). Exercising provides some stress relief.
- Reading: Escape from reality completely by reading. Reading can help you to de-stress by taking your mind off everyday life.
- Friendship: Having friends who are willing to listen and support one through good and bad times is essential.
- Humor: Adding humor to a stressful situation can help to lighten the mood.
- Hobbies: Having creative outlets such as listening to music, drawing or gardening are great ways to relax and relieve everyday stress.
- Spirituality Actively believing in a higher power or divine being can have many health benefits. In recent studies, it has been found that people who pray have better mental health than those who do not.
- Pets: Taking care of a pet helps distract the mind from stressful thoughts. Studies Show that pets are a calming influence in people’s lives.
- Sleeping The human body needs a chance to rest and repair itself after a long and stressful day. Sleeping gives the body this chance so that it is ready to perform another day.
- Nutrition Eating foods that are good for you not only improve your physical health, but they play a major role in your mental health. When your body gets the proper nutrients, it is better able to function in every capacity.
There are also negative coping skills which can hinder progress in dealing more positively with stress. Actions that are harmful to both mental and physical health include:
- Excessive alcohol use
- Ignoring or storing hurt feelings
- Excessive working
- Avoiding problems
These actions offer only temporary relief, if any, from stress. Ignoring or covering up how you feel does not solve the problem and the next time the situation arises, you will still have no way of dealing with it.
The next time you find yourself faced with a difficult or stressful circumstance, remember to practice your new coping skills. These skills lead to good mental health and happier you.
Ten Tips for Better Mental Health
- Build Cofidence – identify your abilities and weaknesses together, accept them, build on them and do the best you can with what you have.
- Accept Compliments – many of us have difficulty accepting kindness from others but we all need to remember the positive in our lives when times get tough.
- Make Time for Family and Friends – these relationships need to be nurtured; if taken for granted they will dwindle and not be there to share life’s joys and sorrows.
- Give and Accept Support – friends and family relationships thrive when they are “put to the test.” Just as you seek help when you are having a tough time, a friend or family member might come to you in their time of need.
- Create a Meaningful Budget – financial problems are big causes of stress, especially in today’s economy. Over-spending on our “wants” instead of our “needs” can compound money worries. Writing down where you money is going helps you keep a closer eye on your finances.
- Volunteer – being involved in community gives a sense of purpose and satisfaction that paid work cannot. Find a local organization where you life skills can be put to good use.
- Manage Stress – we all have stressors in our lives but learning how to deal with them when they threaten to overwhelm us will help to maintain our mental health.
- Find Strength in Numbers – sharing a problem with others who have had similar experiences may help you find a solution and will make you feel less isolated. Even talking about situation with people who have not experienced what you are going through is a good way to gain outside perspective.
- Identify and Deal with Moods – we all need to find safe and constructive ways to express our feelings of anger, sadness, joy and fear. Channeling your emotions creatively is a wonderful way to work off excess feelings. Writing (keeping a journal), painting, dancing, making crafts, etc. are all good ways to help deal with emotions.
- Learn to Be at Peace with Yourself – get to know who you are, what makes you really happy and learn to balance what you can and cannot change about yourself.
Gathering Accurate Information
Certainly, one of the easiest ways for me to deal with almost anything that comes my way is having the correct information. Often times, people and life are pretty complex, and with that, comes the necessity of requiring certain information to accomplish certain things – most people have a desire to do things, like go to college, or get employed. If someone is told inaccurate information, or nothing at all, that could lead to the outcome desired, problems are bound to develop.
Credible sources are incredibly important in this regard, as I am uninterested in flimsy, or merely persuasive arguments that deal with one’s personal agenda.
Socializing and Meaningful Relationships
Having an active social life, and meaningful relationships with others, goes a hell of a long way. It’s an essential life saver for me. The things most meaningful to me always came in great conversations with people.
I have a strong tendency to despise constant complainers, those really quick to judge others, sweeping generalizations, and small talk because these don’t even constitute a conversation. They constitute nothing, like the vacant of words from the most vacant of people, which they obvious feel when speaking to me. Vacant. It means by virtue of the person feeling that way, I will feel that way, too.
Best advice: Don’t tell me something you think I will like hearing.
None of those things establishes how I can relate to the person, or in any way how I can understand them, which is absolutely crucial towards meaning. If there is no meaning established in the conversation, especially by me, the best bet is to assume that it probably never happened. When meaningful things take place, I am more than willing to always acknowledge them.
Certainly, I have utilized post-traumatic growth as a good tool to overcome adversity, as government and politics, key interests of mine, play a huge role in this. These things include Foreign Policy, International/National Security, Gender and Racial Equity, and LGBTQ rights. According to the American Psychological Association:
As Kay Wilson struggled to make her way through a Jerusalem forest after being repeatedly stabbed by a Palestinian terrorist, she distracted herself from her agony by playing the song “Somewhere Over the Rainbow” in her mind, composing a new piano arrangement while she fought for breath and forced herself to put one bare foot in front of the other.
Wilson, then 46, had been working as a tour guide when, on Dec. 18, 2010, she and a friend were ambushed by terrorists. Wilson witnessed her friend’s murder and was herself viciously stabbed with a machete, ultimately playing dead as her attacker plunged his knife into her chest a final time.
She eventually recovered from her severe physical wounds and is healing from her psychological trauma. She now speaks to global audiences about her survival, hoping to “dispel hatred, whether toward Arabs or Jews.”
The work “helps me make meaning out of something so senseless,” says Wilson, who is also writing a book about her experiences.
After the attack, Wilson had flashbacks and deep survivor’s guilt. But like many people who have survived trauma, she has found positive change as well—a new appreciation for life, a newfound sense of personal strength and a new focus on helping others.
Post-traumatic growth (PTG) is a theory that explains this kind of transformation following trauma. It was developed by psychologists Richard Tedeschi, PhD, and Lawrence Calhoun, PhD, in the mid-1990s, and holds that people who endure psychological struggle following adversity can often see positive growth afterward.
“People develop new understandings of themselves, the world they live in, how to relate to other people, the kind of future they might have and a better understanding of how to live life,” says Tedeschi.
How can clinicians use PTG theory to help patients? How has new research helped refine understanding of it? Here’s a look at developments in the field.
Signs of post-traumatic growth
PTG can be confused with resilience, but the two are different constructs (see “The post-traumatic growth inventory” below).
“PTG is sometimes considered synonymous with resilience because becoming more resilient as a result of struggle with trauma can be an example of PTG—but PTG is different from resilience, says Kanako Taku, PhD, associate professor of psychology at Oakland University, who has both researched PTG and experienced it as a survivor of the 1995 Kobe earthquake in Japan.
“Resiliency is the personal attribute or ability to bounce back,” says Taku. PTG, on the other hand, refers to what can happen when someone who has difficulty bouncing back experiences a traumatic event that challenges his or her core beliefs, endures psychological struggle (even a mental illness such as post-traumatic stress disorder), and then ultimately finds a sense of personal growth. It’s a process that “takes a lot of time, energy and struggle,” Taku says.
Someone who is already resilient when trauma occurs won’t experience PTG because a resilient person isn’t rocked to the core by an event and doesn’t have to seek a new belief system, explains Tedeschi. Less resilient people, on the other hand, may go through distress and confusion as they try to understand why this terrible thing happened to them and what it means for their world view.
To evaluate whether and to what extent someone has achieved growth after a trauma, psychologists use a variety of self-report scales. One that was developed by Tedeschi and Calhoun is the Post-Traumatic Growth Inventory (PTGI) (Journal of Traumatic Stress, 1996). It looks for positive responses in five areas:
- Appreciation of life.
- Relationships with others.
- New possibilities in life.
- Personal strength.
- Spiritual change.
The scale is being revised to add new items that will expand the “spiritual change” domain, says Tedeschi. This is being done “to incorporate more existential themes that should resonate with those who are more secular” as well as reflect cross-cultural differences in perceptions of spirituality.
A predisposition for growth?
How many people experience PTG? Tedeschi prefers not to put a hard number on it.
“It all depends on the trauma, the circumstances, the timing of the measurement … [and] on how you define growth using the PTGI, looking at total score, means, factors or individual items,” he says. However, he estimates that about one-half to two-thirds of people show PTG.
Some PTG researchers have tried to corroborate self-reported growth by questioning friends and family members about whether growth “sticks.”
“We are getting more studies that show that PTG is generally stable over time, with a few people showing increases and a few showing decreases,” Tedeschi says. “It is now up to us to learn what is going on with those who change over time, but the evidence is for stability in general, and also corroboration by others.”
There appear to be two traits that make some more likely to experience PTG, says Tedeschi: openness to experience and extraversion. That’s because people who are more open are more likely to reconsider their belief systems, says Tedeschi, and extroverts are more likely to be more active in response to trauma and seek out connections with others.
Women also tend to report more growth than men, says Tedeschi, but the difference is relatively small.
Age also can be a factor, with children under 8 less likely to have the cognitive capacity to experience PTG, while those in late adolescence and early adulthood—who may already be trying to determine their world view—are more open to the type of change that such growth reflects, says Tedeschi.
There also may be genetic underpinnings for PTG, but researchers are just beginning to tease this out. In a 2014 study in the Journal of Affective Disorders, for example, Harvard social and psychiatric epidemiologist Erin Dunn, ScD, and a team of researchers examined data previously collected from over 200 Hurricane Katrina survivors and found that variants in the gene RGS2 significantly interacted with levels of exposure to the hurricane to predict PTG. RGS2 is linked to fear-related disorders, such as post-traumatic stress disorder, panic disorder and anxiety.
Dunn calls the results “very interesting” but notes that “we have to be somewhat cautious in interpreting it because we were unable to find a similar sample to replicate that finding.”
Sarah Lowe, PhD, of Montclair State University, who worked with Dunn on the research, says one difficulty with gene studies for PTG is the concept’s complexity. “If you look at what predicts PTG, it is often psychological stress and dysfunction—but also more positive personality traits like optimism and future orientation, which you’d expect would have a very different genetic basis,” she says.
Theory into practice
Is it possible to prepare people for PTG, to pave the way should tragedy or trauma strike? Yes, says Tedeschi, noting that psychologists can “allow people to understand that this may be a possibility for themselves” and is a “fairly normal process” if and when trauma occurs.
More often, though, therapists will become involved not before adversity has occurred, but afterward. In this context, they can introduce PTG concepts but need to take care doing so.
H’Sien Hayward, PhD, cautions that therapists should not “jump right into the possibility of growth,” which she says can “often be construed as minimizing someone’s pain and suffering and minimizing the impact of the loss.”
Hayward, who works with veterans at VA Long Beach Medical Center in Long Beach, California, knows about such growth firsthand: She was paralyzed in a car accident when she was 16, ending a competitive athletic career. She overcame that trauma through the help of supportive family and friends, went on to study social psychology at Harvard and has traveled to more than 42 countries, often on humanitarian missions providing counseling and other support to trauma victims. Today, she credits the accident for increasing her strength of character “exponentially” by forcing her to overcome challenges. She also appreciates life and relationships with others—including the near-daily support in the small tasks of daily living that she gets from friends and strangers alike: “those interactions warm my heart.”
Yet Hayward is careful not to preach the potential for upside to her patients before they are ready. Instead, she waits for them to express “some positive reaction to the event.”
She also helps patients discover what’s meaningful in their lives and then helps them schedule activities involving these interests, such as spending more time with family members or doing volunteer work.
Tedeschi says sometimes traditional therapy for trauma patients gives people short-fix solutions to help them resume daily functions, such as sleep or work, but may not provide them with a way of living “beyond just getting by …. We’ve got to attend to their experience of life and how meaningful, satisfied and fulfilling it is.”
One veterans’ care facility that takes a nontraditional, PTG approach to trauma treatment is Boulder Crest Retreat in Bluemont, Virginia. The private, donor-supported institute provides free, weeklong nonclinical exercises and activities for vets seeking recovery from combat stress. The treatment is led primarily by veterans who have themselves gone through trauma and achieved growth. Vets are encouraged to deal with past traumas while also discovering their underlying strengths, as well as forging connections with others and ultimately finding ways to give back.
After the intensive program, vets are followed for 18 months with regular Skype check-ins.
Kevin Sakaki, a former Marine and intelligence/special operations veteran, entered Boulder Crest’s Warrior program last September and found it transformative. He’s noticed such changes in himself as better communication with his family, less anger (“Things don’t get to me as much”), a deeper appreciation of “the little things,” more generosity and a stronger connection to other people.
Tedeschi is among the psychologists studying the Boulder Crest program’s efficacy as part of a research grant funded by the Marcus Foundation.
He hopes that as vets go through the process at Boulder Crest, they “develop new principles for living that involve altruistic behavior, having a mission in life and purpose that goes beyond oneself, so that trauma is transformed into something that’s useful not only for oneself but for others.”
Additionally, according to the Psychology Today article, “The Trouble With Post-Traumatic Growth“:
It turns out that it is very difficult to separate these two things: the perception that we are better and the actuality that we are. In fact, almost no studies separate perceived and actual growth for a very good reason: It is extraordinarily difficult to know how someone is doing before a trauma occurs.
One remarkable study did just that: they measured a large sample of undergraduates (N = 1,528) at the beginning and the end of a semester. They then identified a group of participants who experienced a traumatic event during the semester that caused considerable distress (n = 122). They asked whether they had grown from the trauma (including “I have a greater feeling of self-reliance” or “I am able to do better things with my life”). In theory, among this trauma-exposed group, if you perceived that you grew from the trauma, you should actually show improvements in your overall functioning. In other words, when you say you think you are better (perceived growth), you are in fact better (actual growth). Well, the researchers found that the perception of growth was unrelated to actual growth. Moreover, the perception of growth was linked to more distress at semester’s end.
In short, just because someone perceives they are better off does not mean that they are. In fact, it may very well mean that they are not.
Perceived Growth Is Likely a “Positive Illusion”
Why would someone perceive that they have grown when they have not? One explanation is that perceiving growth is a way of coping with the event itself. In this framework, post-traumatic growth isn’t growth at all. It’s a “motivated positive illusion” whose purpose is to protect us from the possibility that we may have been damaged. In fact, one unusually rigorous experimental study found that when an event threatens our sense of self, we are more likely to believe that the event made us better in some way.
Alas, this coping strategy is ineffective. People who perceive growth tend to do worse over the short and the long term compared to people who don’t. How do we know? One recent study looked at soldiers returning from a deployment to Iraq. They found that soldiers who reported post-traumatic growth 5 months after returning home saw an increase in PTSD symptoms at 15 months. Another study published this year on survivors of the Oslo bombings, the horrific 2011 massacre in Norway, found the exact same result–early post-traumatic growth = later PTSD. In short, perceiving growth portends worse functioning, not better.
Are There Benefits to Adversity?
Does this mean we cannot benefit from adversity? Absolutely not. But before we can understand how, we have to distinguish between perceptions of change and actual change. When we conflate the two, we walk ourselves down the garden path.
In my next blog post, I’ll discuss an alternative to post-traumatic growth that emerged in a recent paper of mine on survivors of the Virginia Tech campus shootings. We’ll see there how acute adversity can be–strangely and sometimes–just what the doctor ordered.