Fable

It appears that few people consciously intend to make meaning out of trauma or to benefit from it. Posttraumatic Growth is most likely a consequence of attempts at psychological survival.

Tedeschi and Calhoun, Posttraumatic Growth ¹

After a traumatic event, what then? The trauma itself causes significant psychological distress and need for psychological adjustment to alleviate the distress. Without adjustment, the posttraumatic distress persists (and if pathological is PTSD).

Trauma itself is distressing, and its aftermath violates beliefs (our primal assumptions) about the self and the world around. Brewin et al:²

Trauma generally involves a violation of basic assumptions connected with survival as a member of a social group. These include assumptions (not necessarily conscious ones) about personal invulnerability from death or disease, status in a social hierarchy, the ability to meet internal moral standards and achieve major life goals, the continued availability and reliability of attachment figures, and the existence of an orderly relation between actions and outcomes.

The recovery from trauma involves two major processes - healing pain and struggling with consequences - the alleviation of distress and the accommodation of disruption to our physical circumstances and primal assumptions. In fact, if we fail to heal but make some sense, we can have both posttraumatic distress and posttraumatic growth [PTG]. Tedeschi and Calhoun:

This description of [PTG] is positive, because the experience of growth is viewed this way. However, the presence of growth does not necessarily signal an end to pain or distress, and usually it is not accompanied by a perspective that view the crisis, loss, or trauma itself as desirable. Many persons facing devastating tragedies do experience growth arising from their struggles. The events themselves, however, are not viewed as desirable - only the good that has come out of having to face them.

Also,

The person facing a major life crisis must find ways of managing initial distress, which can often be debilitating. This is necessary to allow some degree of constructive cognitive processing to occur, producing schema changes that will contribute to the experience of PTG... [Cognitive processing] leads to disengagement from previous goals and assumptions, as it becomes clear that the old way of living is no longer appropriate in radically changed circumstances [accommodation]. This often lengthy process during which distress persists may actually be important for the maximum degree of PTG to occur. This distress keeps the cognitive processing active, whereas a rapid resolution is probably an indication that the assumptive world was not severely tested, and could [already] accommodate the traumatic events.

The ability to regulate distress is important to PTG. The sensations of threat (e.g. overwhelming sadness, unmanageable rage, freezing terror or violent disgust) trigger dominance or withdrawal responses. When the sensations move outside a victim's window of tolerance, they cause hyper- or hypo-arousal, and these dysregulated states shut down cognitive processing and engage more primate defenses.

After the failure to regulate distress, a victim will create psychological defenses to limit the risk of additional threats. A traditional defense is to repress the experience and identify with a superficial account of the event. This defense functions as a means to preserve old assumptions in the face of the demand for accommodation.

If instead, psychological distress is somehow simply alleviated such that threats do not trigger arousal, then the struggle with the aftermath might be limited to addressing changes to physical circumstances (e.g. the loss of a house). What if a natural disaster caused the fire, put a family member in the hospital and destroyed a computer holding a life's work? What of the senseless violation of primal beliefs? Without the affect-laden experience, without the suffering, how are those losses accommodated? Therapeutic interventions to alleviate distress can limit greater long-term gains.³

How are losses accommodated? The emotion of loss is sadness, and if sadness persists it becomes a mood state symptomatic of depression. Sadness and depressive symptoms are both natural and likely necessary for the process of accommodation and PTG. Sadness abates as unobtainable goals are abandoned and naive beliefs about the self and the world around are discarded. Tedeschi and Calhoun:

In our conception of PTG, there is the additional complication that people who report growth must disengage, or give up, certain goals and basic assumptions, at the same time persisting in an attempt at building new schemas, goals, and meanings. This persistence in cognitive processing should be associated with PTG.

To give up such goals and beliefs without a new sense of direction and understanding is a form of intolerable self-negation. The constructive response to sadness is an important quality to PTG because it mediates the sense of self during a process of loss and growth. Dolbier et al.:⁴

Depressive symptoms negatively related to growth, yet became a positive predictor after controlling for hopeful coping, self-leadership and self-esteem [qualities positively correlated with PTG]. Mediation tests suggested that depressive symptoms exert an indirect negative influence through the mediators of self-leadership and self-esteem; that is, those who have high depressive symptoms may also have lower levels of these personal characteristics, which in turn lead to less growth. Simultaneously, however, depressive symptoms exert a direct positive effect on growth; that is, when self-leadership and self-esteem are controlled, depressive symptoms may serve as a “wake up call” to the individual. These results suggest that growth occurs when individuals have a sufficient foundation of self-leadership and self-esteem present, yet sufficient distress to merit an examination of current beliefs and feelings in the context of past trauma and adaptations. As such, depressive feelings serve as a catalyst to disrupt and then help reshape basic beliefs about oneself and the world (Carver, 1998).

In defense to trauma, we often we deny our helplessness or immediately effort plans to replace the loss. Sadness can short-circuit our defenses. It suppresses our reactivity and arousal, it limits the compulsion to take foolhardy action to replace loss, it reduces our ability to limit rumination or become distracted by other activities, and finally, it facilitates the realization and acceptance of loss.

An event is traumatic in part because we cannot effectively regulate our own sadness. We were helpless and did suffer loss: we were the victim. If we cannot tolerate our sadness, we might make it part of the superficial account and our identity: "It's sad what happened, but I'm OK. I'm cursed, but I've gotten used to it." If instead, we engage more constructive responses, the ones appropriate to the sadness, we seek to be sad for our loss rather than sad for our selves. In this way, we work to tolerate a piece of the intolerable: On the one hand, we struggle to accommodate, and on the other, we suffer our own self-pity. In sadness our accommodation grows and our self-pity diminishes. Sadness mediates the change in self-concept and provides the backdrop for PTG.

Other related articles on PTG:
Posttraumatic Growth from Awe?
Growth from Suffering

1. Tedeschi, R., & Calhoun, L. (2004). TARGET ARTICLE: "Posttraumatic Growth: Conceptual Foundations and Empirical Evidence" Psychological Inquiry, 15 (1), 1-18 DOI: 10.1207/s15327965pli1501_01  ↩

2. Brewin CR, Dalgleish T, Joseph S. A dual representation theory of posttraumatic stress disorder. Psychological Review. 1996;103(4):670-686. ↩

3. Calhoun LG. Facilitating Posttraumatic Growth: A Clinician's Guide (Personality and Clinical Psychology Series). Routledge; 1999. ↩

4. Dolbier, C., Jaggars, S., & Steinhardt, M. (2009). Stress-related growth: pre-intervention correlates and change following a resilience intervention Stress and Health DOI: 10.1002/smi.1275  ↩