Motivation and emotion/Book/2011/Trauma recovery and growth

Trauma Recovery and Growth: What emotions are involved in trauma and trauma recovery, and how can post-traumatic growth be fostered?

This page is part of the Motivation and emotion book. See also: Guidelines.

Completion status: this resource is considered to be complete.

Multimedia presentation (5 min)

“ The ultimate value of life depends upon awareness, and the power of contemplation rather than upon mere survival

~Aristotle

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Key Questions: Have a go at answering these after reading the chapter: * What is emotional trauma? * What treatments are available? * Is it possible to experience posttraumatic growth?

Introduction While the main focus of this chapter is on the possibilities of positive change following a traumatic event, it is important to begin with difficult reminder that traumatic events can produce negative outcomes and emotional distress. However, the question of whether recovery and personal growth are attainable following a traumatic event will be addressed in this chapter, and if the answer is yes - how can these be attained? The definition of trauma and the consequences it has on the emotional aspects of an individual is outlined below, along with some common reactions, and in more serious cases, disorders that may develop following a traumatic experience. What is Trauma? Trauma is defined as a deeply distressing or disturbing event that is experienced or witnessed by an individual. The word trauma is derived from a Greek work meaning ‘wound’. A great deal is known about the treatment for physical trauma – how to mend wounds, fight infections and undergo surgery ect but how do we go about treating the effects of psychological trauma? First, it is important to define what trauma is and the different facets it can occur (Harvard Mental Health Letter, 2003). Experiencing a natural disaster can cause emotional trauma. McCann & Pearlman (1990) define psychological trauma by following three criteria: It is sudden and unexpected It exceeds the individuals perceived ability to meet its demands Disrupts the individuals cognitive functioning and personal schemas The first criteria listed is to distinguish the difference between experiencing difficulties as a result of a traumatic event and experiencing difficulties when no traumatic event has occured. While generalised suffering is at times severe, there needs to be a clear definition in order to discuss relevant treatment for recovery from a traumatic event. Many of us will experience some form of trauma throughout our lifetime, however depending on the severity of the trauma and the surrounding circumstance the psychological trauma that remains will vary among individuals. In other words, it is not the trauma that will determine the psychological damage but the individual’s experience of the event (Jaffe, Segal & Flores, 2005). The traumatic event itself is not the primary focus when seeking treatment, rather it is the emotional aftermath. For example, recent research has revealed that psychological trauma can result from common occurrences such as the breakdown of a significant relationship, a minor car accident, or the loss of a job. On the other end of the psychological trauma can be a result of a more serious event such as war, natural disaster or abuse. Therefore, one person’s reaction to a traumatic event may differ to another person (Foa & Meadows, 1997).

Psychological Trauma Common reactions following a traumatic event Individuals who experience a traumatic event typically go into a state of emotional shock and while there are common reactions to trauma each individual responds in their own way. The most common reaction to trauma is the most obvious emotion, and that is fear. Other common responses are: Fear response – at the time of the event fear is usually the overwhelming emotion, this could be fear of being physically injured or even killed. For some, the initial fear to certain sights, smells or sounds associated to the event can persist for weeks, months or even years. These fears can become paralysing and greatly impact the individual physically, socially and emotionally. Feelings of guilt – sometimes guilty feelings arise as a result of others being seriously harmed during the traumatic event (this is known as survivor’s guilt). The individual may have guilt present due to something they had to do in order to survive, or finally, feeling that the event may have been avoided if they ‘did’ something different. Negative self-image – the view of one’s self is often affected after a traumatic event and low self esteem may be present as a result. Depression – feeling a sense of sadness and/or loss in interest in previously enjoyable activities is common after a traumatic event (National Crime Victims Research and Treatment Center). Posttraumatic Stress Disorder According to the Diagnostic And Statistical Manual of Mental Disorders (APA, 2000), posttraumatic Stress Disorder (PTSD) is the development of symptoms following exposure to a traumatic event. The individual experiences: Intense fear Helplessness or horror as a response to the traumatic event Distressing recurrent and intrusive recollections of the event These recollections may occur via flashbacks, in dreams or feeling as though the traumatic event was actually occurring again. PTSD symptoms result in avoidance behaviours and unbalanced physiological arousal and is characterised by overwhelming memories from the past and is essentially a dissociative phenomenon, due to a failure to integrate trauma into the declarative memory system. As a result of this, trauma can be continuously positioned at a sensory and somatic level – the term somatic means mind/body; so the trauma can be unconsciously triggered and physically re-experienced without conscious memories being present. This is why a dissociative state is linked with symptoms of PTSD and as a consequence the individual is constantly in a state of high arousal, which is extremely difficult for the individual to modulate both psychologically and biologically (De Zulueta, 2006).

The Road to Recovery Recovery from emotional trauma requires courage & resiliance. Therapeutic Interventions Therapeutic interventions have been developed with the aim of assisting individuals who are experiencing emotional trauma. As each individual varies in their response to treatment there is a number of different treatment types listed below, having knowledge of various approaches available will allow the individual to employ the treatment method that best suits them. The treatments discussed in this section are all types of Cognitive Interventions and following this, types of talking therapy and somatic psychotherapy are discussed. Cognitive Behavioural Therapy Cognitive-Behavioural Treatments also known as CBT is an approach that is one of the most common and well established form of treatment for emotional trauma and PTSD. CBT is the process of reconstructing the thoughts of an individual with the aim of producing more a more positive view, while challenging any negative thoughts that are present. There are many different types of CBT and a couple of these will discuss below (Foe, 1997). Psychoeducation There is a common notion that ‘power is knowledge’ and this view can be applied to individuals who are in the process of overcoming their emotional trauma and reach their goal of growth and recovery. Harvey, Bryant & Tarrier (2003) apply this principle to treatment in an approach called Psycho-education, where the individual is provided with information about common symptoms following a traumatic event. This typically occurs during the initial treatment and is linked with psychological debriefing (which is discussed below). The primary aim of this approach is to assist the individual develop an understanding of their symptoms and to determine a foundation for treatment. Exposure Therapy Prolonged imagined exposure involves the individual to vividly imagine the trauma for long-lasting periods. The therapists assists the individual by providing a narrative of their traumatic experience, a typical exposure therapy session lasts for 50 minutes. Potential benefits from this approach are habituation for the individual, which is a process of desenstizing them to the traumatic event, this aims to decrease anxiety and fear associated with the trauma. Another primary aim is to define the trauma as a distinct event that is not suggestive of the world being a threatening or dangerous place (Harvey, Bryant & Tarrier, 2003). Eye Movement Desensitization and Reprocessing Eye movement desentization is a treatment in which the individual is asked to imagine and distressing image that is associated with their traumatic event, along with any bodily sensations that are appropriate to the image. While holding this in their mind, the individual also follows with their eye, the therapist finger. This treatment is repeated until distressing aspects of the imagery are reduced and more positive cognitions emerge in relation to the trauma. Chemtob, Tolin, van der Kolk & Pitman (2000) have found eye movement desentization to be an effective form of treatment for emotional trauma and furthermore PTSD. However, efficacy depends upon the individual’s ability to clearly imagine one particular distressing component of the trauma as oppose to many different images at the one time. Psychological Debreifing There is a general consensus within society that talking about a problem will alleviate feelings of sadness or ‘pent’ up emotions but is there any scientific evidence behind this view? Bisson, McFarlane & Rose (2000) conducted research and has shown that psychological debriefing (PD), a type of talking therapy, is effective in treating emotional trauma. It is typically a single session crisis intervention that occurs soon after the traumatic event (usually within a few days). It aims to reduce and possibly prevent the individual experiencing unwanted recurrent memories, by verbally expressing internal feelings that have arisen because of the event. However, further analysis has shown that PD is not an indicator of preventing later diagnosis of PTSD. Although in most studies individuals felt a sense of relief and felt that debriefing was a positive to their current situation, therefore it is viewed as a valuable tool in alleviating the initial symptoms of emotional trauma. Somatic Psychotherapies Recent developments in effective treatment of emotional trauma include somatic psychotherapies. Remember, the term somatic means brain and body, somatic psychotherapies aim to draw on the mind and body together during treatment. The idea is that in order to change our body we need to engage the brain also – from how we think and feel to the neurobiological connections also. Somatic therapy is an approach that uses physical expressions to release the energy stored in the body following a trauma. The aim of this is to retune the neurological system into equilibrium. An example of this would be a person may re-enact the traumatic event and push their attacker away by forcefully pushing against a wall or a pillow. However, this treatment type requires the confrontation of intense emotions so it is important to find a therapist whom you feel a strong sense of trust and bond with (Linley & Joseph, 2005).

Can a Traumatic Event Have a Positive Impact? From a negative a positive can occur. It is clear that traumatic events can produce many negative outcomes, but what about the possibility of a positive impact from negative events? This concept that 'gain can result from a loss' is fairly new to the field of scientific psychology, however historically there has been vast amounts of literature and philosophies that has conveyed the idea that personal gain is to be found in suffering (Linley, 2003). This idea is central to the existential-humanistic tradition of psychology or positive psychology – wherein the focus is more on understanding and enhancing psychological well-being as well as alleviating distress and maladaptive functioning, the latter known for me traditional psychology (Joseph & Linley 2008). Lets take a closer look at this concept with regards to scientific research. Tedeschi & Calhoun (1996) produced interesting evidence revealing that individuals experience a positive change in self perception following a traumatic experience, the study showed that some burn victims believed their experience occurred to make them better people. A striking statistic of eighty-three percentage of survivors of a sunken ship claimed they felt more experienced about life after the event. Further studies into the positive outcomes from those who have experienced trauma through combat reported that individuals felt a sense of comradeship, enhanced coping skills and appreciation of life. Recovery and growth is not something is an easy process, it takes courage and resilience and usually will require the help of a professional, but it most defiantly is achievable. According to Joseph & Linley (2005) individuals can experience a process called negative accommodation wherein their worldview fundamentally changes after the traumatic event and as a result a self-destructive worldview can evolve. If this occurs, it can be unlearned and replaced with positive accommodation which is a process of reconfiguring the thoughts and view that the individual holds post traumatic experience. This can be achieved by employing the cognitive behavioural interventions that were discussed earlier in the chapter. Postraumatic Growth Tedeschi & Calhoun (2010) are viewed as the pioneers to the research of posttraumatic growth. They have defined the term posttraumatic growth as an individual’s experience of considerable positive change arising from the struggle with a traumatic event. The research they have conducted together with the already existing literature has revealed that the following changes can occur as a result of posttraumatic growth: Increased perception of competence and self-reliance Enhanced acceptance of one's vulnerability and negative emotional experiences Improved relationships with significant others Increased compassion and empathy for others Greater efforts directed at improving relationships Increased appreciation of own existence Greater appreciation for life Positive changes in one's priorities Stronger religious/spiritual beliefs Greater personal intimacy with God Greater sense of control and security through belief in God Greater meaning about life and suffering through religion It is not surprising that certain kinds of personal qualities such as, optimism and openness to experience could increase the likelihood of an individual to engage in some form of posttraumatic growth. However, the presence of these qualities is not imperative for traumatic growth to occur. What is vital to the process is the degree to which the individual cognitively connects to aspects of the previous event, along with the social environment of the individual. Tadeschi & Calhcoun (2009) argue that cognitive awareness is fundamental to posttraumatic growth. This hypothesis is proven in a number of studies, in particular, a study by Bower, Kemeny, Taylor & Fahey (1998) of bereaved HIV positive men found an explicit link between purposeful, repetitive cognitive processing and experiences of personal growth. Similar results were revealed with a study of university students who documented their thoughts and feelings in a journal as well as working on cognitively reconstructing their emotional aspects of the traumas they were coping with (Ullrich & Lutgendorf, 2002). Cadell & Regehr (2003) reviewed numerous studies examining the importance of social support, and the effects it has on assisting individuals to combat the symptoms of a traumatic event. If the individual who is experiencing emotional trauma surrounds themselves with people whom they trust and feel comfortable disclosing to, they are more likely to engage with the available social support. Typically individuals who have encountered trauma, seek to restore equilibrium in their life, and they do this by a process of revaluation and reflection. This process of meaning-making following a trauma can result in personal growth and wisdom. How is posttraumatic growth measured? Posttraumatic growth can be measured using The Posttraumatic Growth Inventory (PTGI), this is a 21 item scaled instrument that measures five domains of growth which are; a greater appreciation of life and changed sense of priorities, warmer and more intimate relationships, increased sense of personal strength, recognition of new possibilities for one’s life and spiritual development (Tedeschi & Calhoun, 2009). Posttraumatic Growth Defined: An individual’s experience of considerable positive change arising from the struggle with a traumatic event. Pathways to Posttraumatic growth: Acceptance Affirmation Determination Confidence Relationships Optimism

Summary Tedeschi & Calhoun (2004) put it simply with the statement that out of loss there can be a gain. Overall these gains are generally reported in areas of increased appreciation for life, more meaningful relationships and awareness of increased personal strength. Numerous studies have found that posttraumatic growth is possible that is, with the aid of certain treatments. These treatments include, CBT, psycho education, exposure therapy, eye movement desensitization, psychological debriefing and somatic psychotherapies. Individuals who possess certain personal qualities such as resilience, courage and optimism are at an advantage of achieving posttraumatic growth; however it is not necessary in order to achieve growth if an individual does not already have these qualities Tadeschi & Calhcoun (2009). Social support has also been found to increase the chance of posttraumatic growth Cadell & Regehr (2003) conducted a meta-anaylisis that revealed positive interpersonal relationships assist the individual in the process of posttraumatic growth. While the concept of posttraumatic growth is relatively new to the field of psychology, the philosophies behind it have been around for centuries, much like much like the message of the symbol of the yin-yang that from a negative there can be a positive and vice versa. However, posttraumatic growth is an area that is now gaining more scientific interest and is being studied more abundantly than in the past – this will allow individuals to know more about posttraumatic growth and how it can be achieved. Remember that each individual reactions differ to a traumatic event, and one treatment that may work for someone may not work for another. It is important to keep this in mind, and find the best method of therapy that suits you. Revisit the 'key questions' listed at the beginning of the chapter - now that you have read the chapter have a go at answering them.

See Also Related book chapters Motivation_and_emotion/Book/Growth_through_adversity Motivation_and_emotion/Book/Handling_stress Motivation_and_emotion/Book/Managing_life_change

External Links http://www.traumacentre.com.au/ http://cust-cf.apa.org/ptgi/ - This link will take you to a posttraumtic inventory checklist.

References Bisson, J., McFarlane, A., & Rose, S. (2000). Psychological debriefing. Journal of Traumatic Stress. 13, 554-556. Bower, J. E., Kemeny, M. E., Taylor, S. E.,&Fahey, J. L. (1998). Cognitive processing, discovery of meaning, CD 4 decline, and AIDS-related mortality among bereaved HIV-seropositive men. Journal of Consulting and Clinical Psychology, 66, 979–986. Chemtob, C., Tolin, D., van der Kolk, A., & Pitman, R. (2000). Eye movement desensitization and reprocessing. Journal of Traumatic Stress, 13, 569-571. De Zulueta, F. (2006). The treatment of psychological trauma from the perspective of attachment research. Journal of Family Therapy. 28, 334-351. Diagnostic And Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association; 2000. Foa, E., & Meadows, E. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Reviews Psychology.48, 449-480. Foa, E. Psychological processes related to trauma after a traumatic event and an effective treatment for PSTD. Annals New York Acadamy of Sciences. Harvard. (2003). After the trauma: what doesn’t help and what may. Retrieved November 3, 2011 from http://www.health.harvard.edu/newsweek/After_the_trauma.htm Harvey, A., Bryant, R., & Tarrier, N. (2003). Cognitive behaviour therapy for posttraumatic stress disorder. Clinical Psychology Review, 23, 501-522. Jaffe, J., Segal, J., & Flores, L. (2005). Emotional and Psychological Trauma: Causes, Symptoms, Effects, and Treatment. Retrieved November 5, 2011 from http://www.helpguide.org/mental/emotional_psychological_trauma.htm Joseph, S., & Linley, P. (2008). Trauma, Recovery, and Growth: Positive Psychological Perspectives on Posttraumatic Stress [Online Version]. Retrieved from http://books.google.com.au/books?hl=en&lr=&id=7K4Qf1b1PtAC&oi=fnd&pg=PR7&dq=Trauma,+Recovery,+and+Growth:+Positive+Psychological+Perspectives+on+Posttraumatic+Stress&ots=7DF9Z8TOhh&sig=9zrkJ3uv9740I_GLaDKtKfMnmeE#v=onepage&q&f=false Liney, A. (2003). Positive adaptation to trauma: Wisdom as both process and outcome. Journal of Traumatic Stress. 16, 601-610. Linley, P., & Joseph, S. (2005). Positive and negative changes following occupational death exposure. Journal of Traumatic Stress, 18, 751-758. McCann, L., & Pearlman, L. (1990). Psychological trauma and the adult survivor: Theory, therapy and transformation. [Online Version]. Retrieved from http://books.google.com.au/books?hl=en&lr=&id=zvNTmfFvkXEC&oi=fnd&pg=PR9&dq=mccann+and+pearlman+1990+trauma&ots=_Sx4p6dxiQ&sig=-BAnVuqvuCMnkj8Iis-hbfewQnY#v=onepage&q&f=false National Crime Victims Research and Treatment Center, Medical University of South Carolina. Victims reaction to a traumatic event. Retrieved November 3, 2011 from http://academicdepartments.musc.edu/ncvc/resources_public/victim_reactions_general_trauma.pdf Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–471. Tedeschi, R. G., & Calhoun, L. G. (2010). Beyond recovery from trauma: Implications from clinical practice and research. Journal of Social Issues, 54, 357-371. Tedeschi, R. G., & Calhoun, L. G. (2009). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. London: Psychology Press. Ullrich, P. M., & Lutgendorf, K. (2002). Journaling about stressful events: Effects of cognitive processing and emotional expression. Annuals of Behavioural Medicine, 24, 244–250.