POSTTRAUMATIC GROWTH

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POSTTRAUMATIC GROWTH

• Gloria Collins, Psy.D.
• Assiniboine/Sioux
• Behavioral Health Consultant

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That which does not kill us, makes us stronger
Friedrich Neitzsche

• In contrast to Neitzsches well known quote,
  traumatic experiences may lead to psychiatric
  conditions such as posttraumatic stress disorder
  (PTSD)
• However, such psychopathology occurs only among a
  minority of those exposed to trauma, leaving open
  the possibility of other outcomes, including
  positive benefits (Bonanno, 2004).

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Goals of PTG Presentation

• This presentation aims at summarizing
  conceptualizations of posttraumatic growth (PTG)
  and addresses the adaptive significance of this
  phenomenon for Native American People.
• At the end of this presentation, participants
  will be familiar with the concept of PTG and be
  able to discuss fruitful future research
  directions and PTG can add a new, positive
  perspective into the treatment of trauma for
  Native American individuals, families, and
  communities.

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Posttraumatic Growth

• Positive effects of struggling with adversity
  have been prominent themes throughout history as
  reflected in literature and philosophy
  (Kierkegaard, 1983 Nietzsche, 1955)
• In the clinical literature as well, many authors
  have acknowledged the potential for growth from
  adversity (e.g., Caplan, 1964 Finkel, 1974
  Frankl, 1961)

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PTG Reflects a Paradigm Shift

• In line with a reviving interest in positive
  psychological processes, it is only recently that
  the phenomenon of PTG has elicited the attention
  of clinicians and has inspired systematic
  research
• Richardson (2002) depicts the growing interest in
  PTG as part of a paradigm shift away from a
  reductionistic, problem-oriented approach to
  nurturing strengths as a prevalent theme

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Definitions (PTSD)

• Traumatic events are defined by the APA (1994) as
  events that involve actual or threatened death or
  serious injury
• The response of the person who was exposed to
  such a traumatic event has to be one of fear,
  helplessness, or horror
• Posttraumatic stress disorder (PTSD) is a common
  psychiatric disorder after trauma

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PTSD Clusters

• Persistent Re-experiencing of the traumatic
  event/events
• Persistent Avoidance of internal/external cues
  associated with trauma
• Persistent Increased Arousal

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Re-experiencing

• Recurrent recollections/intrusive thoughts of the
  trauma
• Recurrent dreams/nightmares
• Flashbacks

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Avoidance

• Persistent avoidance of internal/external cues
  associated with the trauma
• Avoiding thoughts, activities, inability to
  recall, diminished interest, detachment,
  restricted affect and a sense of foreshortened
  future

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Increased Arousal

• Difficulty sleeping
• Irritability
• Difficulty concentrating
• Hypervigilence
• Exaggerated startle response

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Incidence of PTSD

• Rape 55
• Child sexual or physical abuse 35
• Physical and armed assaults 17
• Severe accidents 7

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Definition of Posttraumatic Growth

• Posttraumatic Growth (PTG) is defined as the
  subjective experience of positive psychological
  change reported by individuals as a result of
  their struggle with trauma
• People report these positive outcomes following
  trauma either as a result or a kind of learning
  that occurred through coping with the trauma

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Positive Psychological Changes After Trauma

• Tedeschi Calhoun (1995) identified positive
  psychological changes that can occur following a
  traumatic event
• Improved relationships with others
• Openness to new possibilities
• Greater appreciation of life
• Enhanced personal strength
• Spiritual development

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Mechanism for PTG

• Tedeschi Calhoun (2004) suggest that PTG occurs
  primarily following stressful life events and
  this process requires individuals to reorganize
  her/his meaningfulness of the world and oneself
• Changes in assumptions are considered to be
  crucial for growth because they force one to seek
  meaning to compensate for the incomprehensibility
  of the traumatic event
• Park (2004) further suggest that assumptions
  about self worth are especially important for
  defining personal growth.

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Engelkemeyer Marwit (2008)

• Investigated whether changes in world assumptions
  (Janoff-Bulman, 1992) are necessary for PTG to
  occur and whether significant distress inhibits
  or is unrelated to PTG is a sample of bereaved
  parents who lost a child.
• In their regression model, assumptions about
  self-worth were the strongest predictor of PTG,
  after accounting for time since their loss and
  intensity of distress
• Findings suggest that having more positive
  beliefs regarding worthiness of the self are more
  likely to report PTG
• Suggestions for further study brought about by
  this study suggested that investigators examine
  roles after loss that lead parents to question
  Who am I now?

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Trauma Roles

• Acute, chronic, and historical trauma for Native
  People have forced unnatural roles in Native
  Communities referred to a the trauma triad
• Victim
• Survivor
• Rescuer

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Unnatural Roles

• Unresolved trauma has forced Native People to set
  aside natural, healthy, traditional roles (Gene
  Thin Elk, personal communication)
• Institutions, such as schools, social service and
  health programs have reinforced unnatural roles
  (e.g., loss of voice, dignity, power)

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PTG Roles

• The term growth underscores that the person has
  developed beyond the previous level of
  adaptation, psychological functioning or life
  awareness
• PTG brings about the awareness that there is
  something new or revived that signifies an
  additional benefit compared to pre-trauma level

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PTSD/PTG

• Under the many levels of trauma, Native People
  have the roles, ceremonies, language, and culture
  
• PTSD suppresses the natural ways and keeps
  Native People in an unnatural state
• PTG opens Native People to the reclamation of the
  natural and healing ways of our People

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PTSD/PTG Outcomes

• PTSD
• Reliance on unhealthy coping (i.e., alcohol
  drugs, gambling, etc.)
• Reliance on medical model/medications, sources
  outside self
• Co-occurring d/o
• Individual/community acceptance of negative
  outcomes

• PTG
• Allows for individual communities to develop
  new/healthy priorities
• Establishes healthy individual and community
  voice (social norms)
• Deepened sense of life meaning/purpose
• Heightened sense of identity
• Deepened sense of spirituality

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Balance of PTSD and PTG

• Community values can strike the balance between
  the negative and positive effects
• The research can be Native community
  participatoryto give voice, empower, and
  re-establish natural individual, family, and
  community norms
• Or, we can continue to be victimized,
  disempowered, and adapted to unnatural ways
  Gene Thin Elk, Lakota