(Adapted from materials very generously provided by Sandra A. Lopez, LCSW, ACSW)
Strategies for Promoting Professional Self-Care and Resilience
Brenner, M. J. (2010). Zen practice: A training method to enhance the skills of clinical social workers. Social Work in Health Care, 48(4), 462-470.
Davis, M., Eshelman, E. R., & McKay, M. (2000). The relaxation and stress reduction workbook (5th edition). Oakland, CA: New Harbinger Publications.
Dewane, C. J. (2006). Use of self: A primer revisited. Clinical Social Work Journal, 34(4), 543-558.
Kottler, J. A. & Chen, D. (2008). Activities manual for stress management and prevention: Applications to daily life. Belmont, CA: Thomson Wadsworth.
Rake, C., & Paley, G. (2009). Personal therapy for psychotherapists. The impact on therapeutic practice. A qualitative study using interpretative phenomenological analysis. Psychodynamic Practice, 15(3), 275-294.
Ruiz, D. M. (1997). The four agreements. San Rafael, CA: Amber Allen Publishing.
Rothschild, B. (2006). Help for the helper: Self-care strategies for managing burnout and stress. New York: W. W. Norton.
Skovholt, T. M. (2001). The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists, teachers, and health professionals. Boston, MA: Allyn & Bacon.
Stamm, B. H. (1999). Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (2nd edition). Baltimore, MD: Sidran Press.
Stebnicki, M. A. (2008). Empathy fatigue: Healing the mind, body, and spirit of professional counselors. New York: Springer Publishing.
Stromm-Gottfried, K., & Mowbray, N. D. (2006). Who heals the helper: Facilitating the social worker’s grief. Families in Society: The Journal of Contemporary Social Services, 87(1), 9-15.
Impact of Helping: Secondary/Vicarious Trauma and Retraumatization
Adams, K. B., Matto, H. C., & Harrington, D. (2001). The Traumatic Stress Institute Belief Scale as a measure of vicarious trauma in a national sample of clinical social workers. Families in Society, 82(4), 363-371.
Arledge, E. & Wolfson, R. (2001). Care of the clinician. In M. Harris & R. D. Fallot (Eds.), Using trauma theory to design service systems (pp. 91-97). San Francisco, CA: Jossey-Bass.
Bober, T. & Regehr, C. (2005). Strategies for reducing secondary or vicarious trauma: Do they work? Brief Treatment and Crisis Intervention, 6, 1- 9.
Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1), 63-70.
Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2003). Development and validation of the secondary traumatic stress scale. Research on Social Work Practice, 14(1), 27-35.
Cunningham, M. (2003). Impact of trauma work on social work clinicians: Empirical findings. Social Work, 48(4), 451-459.
Dunkley, J. & Whelan, T. A. (2006). Vicarious traumatisation: Current status and future directions. British Journal of Guidance & Counselling, 34(1), 107-115.
Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatizaation of mental health therapists: Identifying protective practices. Psychotherapy Theory: Research, Practice, Training, 46(2), 203-219.
Kanter, J. (2007). Compassion fatigue and secondary traumatization: A second look. Clinical Social Work Journal, 35, 289-293.
Lahad, M. (2000). Darkness over the abyss: Supervising crisis intervention teams following disaster. Traumatology, 6(4), Article 4.
McCann, L. L., & Pearlman, L. A. (1990). Vicarious traumatization: A contextual model for understanding the effects of trauma on helpers. Journal of Traumatic Stress, 3, 131-149.
Munroe, J. F. (1999). Ethical issues associated with secondary trauma in therapists. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (2nd edition)(pp. 211-229). Baltimore, MD: Sidran Press.
Naturale, A. (2007). Secondary traumatic stress in social workers responding to disasters: Reports from the field. Clinical Social Work Journal, 35, 173-181.
Pearlman, L. A. (1999). Self-care for trauma therapists: Ameliorating vicarious traumatization. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (2nd edition)(pp. 51-64). Baltimore, MD: Sidran Press.
Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W. W. Norton.
Perry, B. D. (2003). The cost of caring: Secondary traumatic stress and the impact of working with high-risk children and families. Archived at: http://www.ChildTrauma.org.
Pulido, M. L. (2007). In their words: Secondary traumatic stress in social workers responding to the 9/11 terrorist attacks in New York City (commentary). Social Work, 52(3), 279-281.
Saakvitne, K. W., Pearlman, L. A., & staff of the Traumatic Stress Institute (1996). Transforming the pain: A workbook on vicarious traumatization. New York: W. W. Norton.
Stamm, B. H. (Ed). (1999). Secondary traumatic stress: Self-care issues for clinicians, researchers and educators (2nd edition). Baltimore, MD: Sidran Press.
Stamm, B. H., Varra, E. M., Pearlman, L. A., & Giller, E. (2002). The helper’s power to heal and to be hurt — or helped — by trying. Washington, DC: National Register of Health Service Providers in Psychology.
Trippany, R. L., White Kress, V. E., & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counselors should know when working with trauma survivors. Journal of Counseling & Development, 82, 31-37.
Williams, M. B. & Sommer, J. F. (1999). Self-care and the vulnerable therapist. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (2nd edition)(pp. 230-246). Baltimore, MD: Sidran Press.
Impact of Helping: Burnout and Stress
Acker, G.M. (1999). The impact of clients’ mental illness on social workers’ job satisfaction and burnout. Health and Social Work, 24(2), 112-119.
Arches, J. (1991). Social structure, burnout, and job satisfaction. Social Work, 36, 193-272.
Deighton, R. M., Gurris, N., & Traue, H. (2007). Factors affecting burnout and compassion fatigue in psychotherapists treating torture survivors: Is the therapist’s attitude to working through trauma relevant? Journal of Traumatic Stress, 1, 63-75.
Cherniss, C. (1980). Staff burnout: Job stress in the human services. Beverly Hills, CA: Sage.
Daley, M. R. (1979). Burnout: Smoldering problem in protective services. Social Work, 24, 375-379.
Gillespie, D. (Ed). (1986). Burnout among social workers. Journal of Social Service Research, 10(1), 1-104.
Jayaratne, S., & Chess, W. A. (1984). Job satisfaction, burnout, and turnover: A national study. Social Work, 29, 448-452.
Kim, H. & Ji, J. (2009). Factor structure and longitudinal invariance of the Maslach Burnout Inventory. Research on Social Work Practice, 19, 325-339.
Kim, H. & Stoner, M. (2008). Burnout and turnover intention among social workers: Effect of role, stress, job autonomy, and social support. Administration in Social Work, 32(3), 5-25.
Maslach, C. (1993). Burnout: A multidimensional perspective. In W. B. Schaufeli, C. Maslach, & T. Ivlarch (Eds.), Professional burnout: Recent developments in theory and research (pp.19-32). Washington, DC: Taylor & Francis.
Maslach, C. (2003). Burnout: The cost of caring. Cambridge, MA: Malor Books.
McCarter, A. K. (2007). The impact of hopelessness and hope on the social work profession. Journal of Human Behavior in the Social Environment, 15(4) 107-124.
Powell, W. E. (1994). The relationship between feelings of alienation and burnout in social work. Families in Society: The Journal of Contemporary Human Services, 75(4), 229-235.
Poulin, J. & Walter, C. (1993). Social worker burnout: A longitudinal study. Social Work Research and Abstracts, 29(4), 5-11.
Pasupuleti, S., Allen, R. I., Lambert, E. G., & Cluse-Tolar, T. (2009). The impact of work stressors on the life of social service workers: A preliminary study. Administration in Social Work, 33, 319-339.
Schwartz, R. H., Tiamiyu, M. F., & Dwyer, D. J. (2007). Social worker hope and perceived burnout: The effects of age, years in practice and setting. Administration in Social Work, 31(4), 103-119.
Soderfeldt, M., Soderfeldt, B., & Warg, L. (1995). Burnout in social work. Social Work, 40(5), 638-646.
Stromm-Godfreid, K. & Mowbray, N. D. (2006). Who heals the helper? Facilitating the social worker’s grief. Families in Society: The Journal of Contemporary Social Services, 87, 9-15.
Sze, W. & Ivker, B. (1986). Stress in social work: The impact of setting and role. Social Casework, 67, 141-148.
Um, M. & Harrison, D. F. (1998). Role stressors, burnout, mediators, and job satisfaction: A stress-strain-outcome model and an empirical test. Social Work Research, 22(2), 100-115.
Impact of Helping: Compassion Fatigue
Adams, R. B., Boscarino, J. A., & Figley, C. R. (2006). Compassion fatigue and psychological distress among social workers: A validation study. American Journal of Orthopsychiatry, 76(1), 103-108.
Boscarino, J. A., Figley, C. R., & Adams, R. E. (2004). Compassion fatigue following the September 11 terrorist attacks: A study of secondary trauma among New York City social workers. International Journal of Emergency Mental Health, 6(2), 57-66.
Bride, B. E. & Figley, C. R. (2007). The fatigue of compassionate social workers: An introduction to the special issue on compassion fatigue. Clinical Social Work, 35, 151-153.
Bride, B. E., Radey, M., & Figley, C. R. (2007). Measuring compassion fatigue. Clinical Social Work, 35, 155-163.
Deighton, R. M., Gurris, N., & Traue, H. (2007). Factors affecting burnout and compassion fatigue in psychotherapists treating torture survivors: Is the therapist’s attitude to working through trauma relevant? Journal of Traumatic Stress, 1, 63-75.
Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.
Figley, C. R. (2002). Treating compassion fatigue. New York: Brunner/Mazel.
Figley, C. R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self-care. Journal of Clinical Psychology, 58(11), 1433-1441.
Gentry, J. E., Baranowsky, A. B., & Dunning, K. (1999). ARP: The Accelerated Recovery Program for compassion fatigue. In C. R. Figley (Ed.), Treating compassion fatigue (pp. 123-138). New York: Brunner-Routledge.
Kanter, J. (2007). Compassion fatigue and secondary traumatization: A second look. Clinical Social Work Journal, 35, 289-293.
Radey, M. & Figley, C. R. (2007). The social psychology of compassion. Clinical Social Work, 35, 207-214.
White, G. D. (2001). Near ground zero: Compassion fatigue in the aftermath of September 11. Traumatology, 7(4), 151-154.
Social Work Education
Cunningham, M. (2004). Teaching social workers about trauma: Reducing the risks of vicarious traumatization in the classroom. Journal of Social Work Education, 40(2), 305-3 17.
Dane, B. (2002). Duty to inform: Preparing social work students to understand vicarious traumatization. Journal of Teaching in Social Work, 22(3/4), 3-19.
Dziegielewski, S. F., Roest-Marti, S., & Turnage, B. (2004). Addressing stress with social work students: A controlled evaluation. Journal of Social Work Education, 40(1), 105-119.
Moran, C. C. & Hughes, L. P. (2006). Coping with stress: Social work students and humour. Social Work Education, 25(5), 501-517.
Ying, Y. (2008). The buffering effect of self-detachment against emotional exhaustion among social work students. Journal of Religion and Spirituality in Social Work: Social Thought, 27(1-2), 127-146.
Ying, Y. (2009). Contribution of self-compassion to competence and mental health in social work students. Journal of Social Work Education, 45(2), 309-323.
Social Work Settings
Child Welfare/Sexual Abuse
Anderson, D. G. (2000). Coping strategies and burnout among veteran child protection workers. Child Abuse and Neglect, 24, 839-848.
Barth, R. P., Lloyd, C., Christ, S. L., Chapman, M. V., & Dickinson, N. S. (2008). Child welfare worker characteristics and job satisfaction: A national study. Social Work, 53(3), 199-209.
Couper, D. (2000). The impact of the sexually abused child’s pain on the worker and the team. Journal of Social Work Practice, 14(1), 9-16.
Cornille, T. A. & Meyers, T. W. (1999). Secondary traumatic stress among child protective service workers: Prevalence, severity and predictive factors. Traumatology, 5(1), 15-31.
Csikai, B.. L., Herrin, C., Tang, M. & Church, W. T. (2008). Serious illness, injury, and death in child protection and preparation for end-of-life situations among child welfare services workers. Child Welfare, 87(6), 49-70.
Dane, B. (2000). Child welfare workers: An innovative approach for interacting with secondary trauma. Journal of Social Work Education, 36(1), 27-38.
Horwitz, M. (1998). Social worker trauma: Building resilience in child protective social workers. Smith College Studies in Social Work, 68(3), 364-377.
Pistorius, K. D., Feinauer, L. L., Harper, J. M., Stabmann, R. F., & Miller, R. B. (2008). Working with sexually abused children. The American Journal of Family Therapy, 36, 181-195.
Pryce, J., Shackelford, K., & Pryce, D. (2007). Secondary traumatic stress and the child welfare professional. Chicago, IL: Lyceum Books.
Regehr, C., Hemsworth, D., Leslie, B., Howe, P., & Chau, S. (2004). Predictors of post-traumatic distress in child welfare workers: A linear structural equation model. OACAS Journal, December, 48(4), 25-30.
Stalker, C. A., Mandell, D., Frensch, K. W., Harvey, C., & Wright, M. (2007). Child welfare workers who are exhausted yet satisfied with their jobs: How do they do it? Child and Family Social Work, 12, 182-191.
Walker, M. (2004). Supervising practitioners working with survivors of childhood abuse: Countertransference, secondary traumatization and terror. Psychodynamic Practice, 10(2), 173-193.
End of Life/Hospice/Grief
Davidson, K. W. & Foster, Z. (1995). Social work with dying and bereaved clients: Helping workers. Social Work in Health Care, 21(4), 1-17.
Jones, S. H. (2005). A self-care plan for hospice workers. American Journal of Hospice and Palliative Medicine, 22, 125-128.
Katz, R. S. & Johnson, T. A. (2006). When professionals weep: Emotional and countertransference responses in end-of-life care. New York: Routledge.
Larson, D. G. (1993). The helper’s journey: Working with people facing grief loss, and lifethreatening illness. Champaign, IL: Research Press.
Walsh-Burke, K. (2006). Grief and loss: Theories and skills for helping professionals. Boston: Pearson Education, Inc.
Family Social Work/Family Therapy/Family Violence
Bell, H. (2003). Strengths and secondary trauma in family violence work. Social Work, 48(4), 513-522.
Bell, H., Kulkarni, S., & Dalton, L., (2003). Organizational prevention of vicarious trauma. Families in Society: The Journal of Contemporary Human Services. 84(4), 463-470.
Figley, C. R. & Figley, K. R. (2009). Stemming the tide of trauma systematically: The role of family therapy. The Australian and New Zealand Journal of Family Therapy, 30(3), 173-183.
Ospina-Kammerer, V. & Dixon, D. R. (2001). Coping with burnout: Family physicians and family social workers—what do they have in common? Journal of Family Social Work, 5(4), 85-93.
Badger, K., Rouse, D., & Craig, C. (2008). Hospital social workers and indirect trauma exposure: An exploratory study of contributing factors. Health in Social Work, 33(1), 63-71.
Bourassa, D. B. (2009). Compassion fatigue and the adult protective services worker. Journal of Gerontological Social Work, 52, 215-229.
Cohen, M. & Gagin, R. (2005). Can skill development training alleviate burnout in hospital social workers? Social Work in Health Care, 40(4), 83-97.
Dane, B. & Chachkes, B. (2001). The cost of caring for patients with an illness: Contagion to the social worker. Social Work in Health Care, 33, 31-51.
Demmer, C. (2004). Burnout: The health care worker as survivor. AIDS Reader, 14, 522-537.
Egan, M. (1993). Resilience at the front lines: Hospital social workers with AIDS patients and burnout. Social Work in Health Care, 18(2), 109-125.
Gellis, Z. D. (2002). Coping with occupational stress in healthcare: A comparison of social workers and nurses. Administration in Social Work, 26(3), 37-52.
Leon, A. M., Altholz, J. A. S., & Dziegielewski, S. F. (1999). Compassion fatigue: Considerations for working with the elderly. Journal of Gerontological Social Work, 32(1), 43-62.
Poulin, J. E. & Walter, C. A. (1993). Burnout in gerontological social work. Social Work, 38(3), 305-310.
Simon, C. E., Pryce, J. G., Roff, L. L. & Klernmack, D. (2005). Secondary traumatic stress and oncology social work: Protecting compassion fatigue and compromising the worker’s worldview. Journal of Psychosocial Oncology, 23(4), 1-14.
Mental Health/Natural Disasters/Terrorism
Butler, L. D., Fischer, P. C., Heldring, M., & Leskin, G. A. (ND). Fostering resilience in response to terrorism among primary care providers.** APA Task Force on Resilience in Response to Terrorism
Campbell, L. (2007). Utilizing compassion fatigue education in Hurricanes Ivan and Katrina. Clinical Social Work, 35, 165-171.
Creamer, T. L. & Liddle, B. J. (2005). Secondary traumatic stress among disaster mental health workers responding to the September 11 attacks. Journal of Traumatic Stress, 18(1), 89-96.
Leitch, M. L., Vanslyke, J., & Allen, M. (2009). Somatic experiencing treatment with social service workers following Hurricanes Katrina and Rita. Social Work, 54(1), 9-18.
Lloyd, C., McKenna, K., & King, R. (2005). Sources of stress experienced by occupational therapists and social workers in mental health settings. Occupational Therapy International, 12(2), 8 1-94.
Munn-Giddings, C., Hart, C., & Ramon, S. (2005). A participatory approach to the promotion of well-being in the workplace: Lessons from empirical research. International Review of Psychiatry, 17, 409-417.
Saakvitne, K. W. & Hudall-Stamm, B. (ND). Fostering resilience in response to terrorism among mental health workers. APA Task Force on Resilience in Response to Terrorism.
Sanders, S., Jacobson, J. M. & Ting, L. (2005). Reactions of mental health social workers following a client suicide or attempt: A qualitative investigation. Omega: Journal of Death and Dying, 51, 197-216.
Ting, L., Jacobson, J. M., & Sanders, S. (2008). Available supports and coping behaviors of mental health social workers following fatal and non-fatal client suicidal behavior. Social Work, 53(3), 211-221.
Ting, L., Jacobson, J. M., Sanders, S., Bride, B. B., & Harrington, D. (2005). The secondary traumatic stress scale (STSS): Confirmatory factor analyses with a national sample of mental health social workers. Journal of Human Behavior in the Social Environment, 11(3/4), 177-194.
Ting, L., Sanders, S., Jacobson, J. M., & Power, J. R. (2006). Dealing with the aftermath: A qualitative analysis of mental health social workers’ reactions after a client suicide. Social Work, 51, 329-341.
Applewhite, H. L. & Arincorayan, D, (2009). Provider resilience: The challenge for behavioral health providers assigned to brigade combat teams. The Army Medical Department Journal, April-June, 2009, 24-30.
Tyson, J. (2007). Compassion fatigue in the treatment of combat-related traumas during wartime. Clinical Social Work Journal, 35, 183-192.
Leyba, E. G. (2009). Tools to reduce overload in the school social worker role. Children & Schools, 31(4), 219-228.
Standards of Practice
Green Cross Academy of Traumatology. (1999). Standards of practice. Available at http://www.greencross.org
NASW (2009). Professional self-care & social work policy statement in Social Work Speaks: National Association of Social Workers Policy Statements 2009-2112 (8th edition). Washington, DC: NASW Press.
↩ Return to Main page.
Posttraumatic growth bibliography
2012 and before.
Table of contents
↩ Return to top
Keywords: Posttraumatic growth, Stress-related growth, Resilience
Common acronyms encountered:
- Changes in Outlook Questionnaire (CiOQ)
- Confirmatory Factor Analyses (CFA)
- Constructivist Self Development Theory (CSDT)
- Disorders of Extreme Stress Not Otherwise Specified (DESNOS)
- Event Related Rumination Inventory (ERRI)
- National Survey of Midlife Development (MIDUS)
- Perceived Benefit Scales (PBS)
- Positive Human Development (PHD)
- Posttraumatic Growth (PTG)
- Posttraumatic Growth Inventory (PTGI) PTGI-short form (PTGI-SF)
- Posttraumatic Stress (PTS)
- Posttraumatic Stress Disorder (PTSD)
- Potentially Traumatic Events (PTEs)
- Psychological Well-Being (PWB)
- Stress-Related Growth (SRG)
- Stress-Related Growth Scale (SRGS)
- Suffering-induced transformational experiences (SITEs)
- Thriving Scale (TS)
- Values in Action (VIA)
Here is a brief and helpful overview:
Positive psychology has fuelled interest in post-traumatic growth over the past decade, but scientific interest in positive changes following adversity was sparked much earlier when a handful of studies appeared in the late 1980s and early 1990s, reporting positive changes in, e.g., rape survivors, male cardiac patients, bereaved adults, survivors of shipping disaster and combat veterans (see Joseph & Butler, 2010 for a review). Then, the topic of post-traumatic stress disorder (PTSD) was relatively new (following its introduction in 1980 by the American Psychiatric Association, 1980) and was attracting research interest. As such, the relatively few observations of positive change lay scattered throughout the literature overshadowed by research on the ways in which trauma could lead to the destruction and devastation of a person's life.
Interest took hold during the 1990s (see, e.g., O'Leary & Ickovics, 1995). Various terms were used throughout the literature to describe the positive changes that survivors' experienced, from, e.g., positive changes in outlook (Joseph, Williams, & Yule, 1993), stress-related growth (Park, Cohen, & Murch, 1996), thriving (Abraido-Lanza, Guier, & Colon, 1998) and perceived benefits (McMillen & Fisher, 1998). But most notably, it was the term post-traumatic growth (Tedeschi & Calhoun, 1996) that researchers gravitated to and has now become the term most widely used to describe this field of study and clinical practice.
Post-traumatic growth is a wide-ranging concept, still in development; but to date, three broad domains of positive change have been noted throughout the literature (Tedeschi & Calhoun, 1996). First, relationships are enhanced in some way. For example, people describe that they come to value their friends and family more and feel an increased sense of compassion for others and a longing for more intimate relationships. Second, people change their views of themselves in some way, e.g., that they have a greater sense of personal resiliency, wisdom and strength, perhaps coupled with a greater acceptance of their vulnerabilities and limitations. Third, people describe changes in their life philosophy, e.g., finding a fresh appreciation for each new day and re-evaluating their understanding of what really matters in life (Joseph, Murphy, & Regel, 2012, p.317).
Following is the text of two articles summarizing posttraumatic growth, Tedeschi and Calhoun (2004c) and Joseph and Butler (2010). I then present an excerpt from an article by Coyne and Tennen (2010) that raises a number of critical concerns about posttraumatic growth. This critical review includes research questioning the Posttraumatic Growth Inventory.
↩ Return to top
1a). Posttraumatic Growth: A New Perspective on Psychotraumatology (Tedeschi, & Calhoun, 2004c).
There is a long tradition in psychiatry, reaching at least back to World War I, of studying the response of people who are faced with traumatic circumstances and devising ways to restore them to psychological health. The main focus of this work has been on the ways in which traumatic events are precursors to psychological and physical problems. This negative focus is understandable and appropriate to the requirements of these contexts. However, only a minority of people exposed to traumatic events develop long-standing psychiatric disorders.
Although not prevalent in either clinical or research settings, there has been a very long tradition of viewing human suffering as offering the possibility for the origin of significant good. A central theme of much philosophical inquiry—and the work of novelists, dramatists and poets—has included attempts to understand and discover the meaning of human suffering (Tedeschi and Calhoun, 1995). In the 20th century, several clinicians and scientists have addressed the ways in which critical life crises offered possibilities for positive personal change (e.g., Caplan, 1964; Frankl, 1963; Maslow, 1970; Yalom and Lieberman, 1991). However, the widespread assumption that trauma will often result in disorder should not be replaced with expectations that growth is an inevitable result. Instead, continuing personal distress and growth often coexist (Cadell et al., 2003).
In the developing literature on posttraumatic growth, we have found that reports of growth experiences in the aftermath of traumatic events far outnumber reports of psychiatric disorders (Quarantelli, 1985; Tedeschi, 1999). This is despite the fact that we are concerned with truly traumatic circumstances rather than everyday stressors. Reports of posttraumatic growth have been found in people who have experienced bereavement, rheumatoid arthritis, HIV infection, cancer, bone marrow transplantation, heart attacks, coping with the medical problems of children, transportation accidents, house fires, sexual assault and sexual abuse, combat, refugee experiences, and being taken hostage (Tedeschi and Calhoun, in press).
The Domains of Posttraumatic Growth
The kinds of positive changes individuals experience in their struggles with trauma are reflected in models of posttraumatic growth that we have been building (Calhoun and Tedeschi, 1998) and in a measure of posttraumatic growth that we developed based on interviews with many trauma survivors (Tedeschi and Calhoun, 1996). These changes include improved relationships, new possibilities for one's life, a greater appreciation for life, a greater sense of personal strength and spiritual development. There appears to be a basic paradox apprehended by trauma survivors who report these aspects of posttraumatic growth: Their losses have produced valuable gains.
We also find that other paradoxes are involved. For example: "I am more vulnerable, yet stronger." Individuals who experience traumatic life events tend to report—not surprisingly—an increased sense of vulnerability, congruent with the experience of suffering in ways they may not have been able to control or prevent. However, these same people also may report an increased sense of their own capacities to survive and prevail (Calhoun and Tedeschi, 1999). Another experience often reported by trauma survivors is a need to talk about the traumatic events, which sets into motion tests of interpersonal relationships—some pass, others fail. They also may find themselves becoming more comfortable with intimacy and having a greater sense of compassion for others who experience life difficulties.
Individuals who face trauma may be more likely to become cognitively engaged with fundamental existential questions about death and the purpose of life. A commonly reported change is for the individual to value the smaller things in life more and also to consider important changes in the religious, spiritual and existential components of philosophies of life. The specific content varies, of course, contingent on the individual's initial belief system and the cultural contexts within which the struggle with a life crisis occurs. A common theme, however, is that after a spiritual or existential quest, philosophies of life can become more fully developed, satisfying and meaningful. It appears that for many trauma survivors, a period of questioning their beliefs is ushered in because existential or spiritual issues have become more salient and less abstract. Although firm answers to the questions raised by trauma—why do traumatic events happen, what is the point to my life now that this trauma has occurred, why should I continue to struggle—are not necessarily found, grappling with these issues often produces a satisfaction in trauma survivors so that they are experiencing life at a deeper level of awareness. It should be clear by now that the reflections on one's traumas and their aftermath are often unpleasant, although necessary in reconstructing the life narrative and establishing a wiser perspective on living that accommodates these difficult circumstances. Therefore, posttraumatic growth does not necessarily yield less emotional distress.
Cognitive Engagement and Growth
A central theme of the life challenges that are the focus here is their seismic nature (Calhoun and Tedeschi, 1998). Much like earthquakes can impact the physical environment, traumatic circumstances, characterized by their unusual, uncontrollable, potentially irreversible and threatening qualities, can produce an upheaval in trauma survivors' major assumptions about the world, their place in it and how they make sense of their daily lives. In reconsidering these assumptions, there are the seeds for new perspectives on all these matters and a sense that valuable—although painful—lessons have been learned.
As the individual comes to recognize some goals as no longer attainable and that some components of the assumptive world can not assimilate the reality of the aftermath of the trauma, it is possible for the individual to begin to formulate new goals and to revise major components of the assumptive world in ways that acknowledge the and cognitive processing of trauma may be assisted by the disclosure of that internal process to others in socially supportive environments. At some point, trauma survivors may be able to engage in a sort of meta-cognition or reflection on their own processing of their life events, seeing themselves as having spent time making a major alteration of their understanding of themselves and their lives. This becomes part of the life narrative and includes an appreciation for new, more sophisticated ways of grappling with life events (McAdams, 1993).
Facilitating Posttraumatic Growth
The changes that trauma produces are experiential, not merely intellectual, and that is what makes them so powerful for many trauma survivors. This is the same for posttraumatic growth—there is a compelling affective or experiential flavor to it that is important for the clinician to honor. Therefore, the clinician's role is often subtle in this facilitation. The clinician must be well-attuned to the patient when the patient may be in the process of reconstructing schemas, thinking dialectically, recognizing paradox and generating a revised life narrative. What follows are some general guidelines for this process. More extensive discussion and case examples can be found in Calhoun and Tedeschi (1999).
Attention to elements of posttraumatic growth is compatible with a wide variety of approaches that are currently utilized to help people who are dealing with trauma. Initially, clinicians should address high levels of emotional distress, providing the kind of support that can help make this distress manageable (Tedeschi and Calhoun, 1995). Allowing a distressed patient to regain the ability to cognitively engage the aftermath of the trauma in a rather deliberate fashion will promote the possibility for posttraumatic growth.
Clinicians must feel comfortable and be willing to help their patients process their cognitive engagements with existential or spiritual matters and generally respect and work within the existential framework that patients have developed or are trying to rebuild in the aftermath of a trauma. Further-more, although individual patients may need additional specific interventions designed to alleviate crisis-related psychological symptoms, listening—without necessarily trying to solve—tends to allow patients to process trauma into growth (Calhoun and Tedeschi, 1999). In fact, one way of insuring that clinicians practice this sort of approach is to relate to the trauma survivor's story in a personal manner. Being changed oneself as a result of listening to the story of the trauma and its aftermath communicates the highest degree of respect for the patient and encourages them to see the value in their own experience. This acknowledged value is a short step away from posttraumatic growth.
The immediate aftermath of tragedy is a time during which clinicians must be particularly sensitive to the psychological needs of the patient. Never engage in the insensitive introduction of didactic information or trite comments about growth coming from suffering. This is not to say that systematic treatment programs designed for trauma survivors should not include growth-related components, because these may indeed be helpful (Antoni et al., 2001). A posttraumatic growth perspective can be used even in critical incident stress management (Calhoun and Tedeschi, 2000). However, even as part of a systematic intervention program, matters related to growth are best addressed after the individual has had a sufficient amount of time to adapt to the aftermath of the trauma.
Caveats About Posttraumatic Growth
In order to clarify the clinical perspective on posttraumatic growth, we offer these reminders. First, posttraumatic growth occurs in the context of suffering and significant psychological struggle, and a focus on this growth should not come at the expense of empathy for the pain and suffering of trauma survivors. For most trauma survivors, posttraumatic growth and distress will coexist, and the growth emerges from the struggle with coping, not from the trauma itself. Second, trauma is not necessary for growth. Individuals can mature and develop in meaningful ways without experiencing tragedy or trauma. Third, in no way are we suggesting that trauma is "good." We regard life crises, loss and trauma as undesirable, and our wish would be that nobody would have to experience such life events. Fourth, posttraumatic growth is neither universal nor inevitable. Although a majority of individuals experiencing a wide array of highly challenging life circumstances experience posttraumatic growth, there are also a significant number of people who experience little or no growth in their struggle with trauma. This sort of outcome is quite acceptable—we are not raising the bar on trauma survivors, so that they are to be expected to show posttraumatic growth before being considered recovered.
↩ Return to top
1b). Positive Changes Following Adversity (Joseph, & Butler, 2010).
Throughout human history the theme of positive changes following adversity is found in literature, religions, and philosophies. Most notable is Nietzsche's famous dictum, "What doesn't kill me makes me stronger." It was an idea also common to the existential and humanistic traditions of psychology of the mid-twentieth century. Viktor Frankl wrote about the will to meaning following his experiences in Theresienstadt and Auschwitz, and Abraham Maslow noted that confrontations with tragedy were often precursors to self-actualization. Scientific interest was sparked when a handful of studies appeared in the late 1980s and early 1990s, reporting positive changes in, for example, rape survivors (Burt & Katz, 1987), male cardiac patients (Affleck, Tennen, Croog, & Levine, 1987), bereaved adults (Edmonds & Hooker, 1992), and combat veterans (Elder & Clipp, 1989).
Interest took hold during the 1990s as the construct was elaborated (e.g., O'Leary & Ickovics, 1995; Tedeschi & Calhoun, 1995) and with the emergence of several psychometric self-report tools, the Changes in Outlook Questionnaire (CiOQ: Joseph, Williams, & Yule, 1993), the Posttraumatic Growth Inventory (PTGI: Tedeschi & Calhoun, 1996), the Stress-Related Growth Scale (SRGS: Park, Cohen, & Murch, 1996), the Perceived Benefit Scales (PBS: McMillen & Fisher, 1998), and the Thriving Scale (TS: Abraido-Lanza et al., 1998). But it is only over the past decade, bolstered by the new positive psychology movement, that the topic has become firmly established as a field of scientific research and clinical interest. Recent major texts include Calhoun and Tedeschi's (2006) Handbook of Posttraumatic Growth, and Joseph and Linley's (2008) Trauma, Recovery and Growth.
Positive changes are difficult to study well, and much of the research is open to criticism. The field is still young, and as such, the reader should beware over-generalized interpretations of specific results to new situations and clinical practice. With apologies to all of those whose work was omitted, we have tried to select articles that r eflect the development of the field and the diversity of contexts and populations that have been studied and that illustrate a method, trend, issue, or conclusion that is important.
The term posttraumatic growth has now become the most widely used term to describe the field. Other terms which have been used include stressrelated growth. There is debate over the use of the term growth, which others have used explicitly to invoke the biological metaphor associated with the humanistic psychology tradition and how growth arises through the resolution of an adversarial tension between pre-existing assumptive worlds and the new trauma-related information. To avoid such theoretical connotations, other terms such as benefit-finding, perceived benefits, and positive change have been used. Although within the literature the various terms are often used inter changeably, it needs to be recognized that different epistemological positions are represented by each. Mindful of this, we have chosen to generally use the term positive change in this brief review.
The bulk of research has relied on the use of the aforementioned, or other similar, retrospective self-report measures. Particularly important have been reviews of the literature. A systematic review of 39 studies by Linley and Joseph (2004) suggested that positive change is commonly reported in around 30-70% of survivors of various traumatic events, including transportation accidents (shipping disasters, plane crashes, car accidents), natural disasters (hurricanes, earthquakes), interpersonal experiences (combat, rape, sexual assault, child abuse), medical problems (cancer, heart attack, brain injury, spinal cord injury, HIV/AIDS, leukaemia, rheumatoid arthritis, multiple sclerosis), and other life experiences (relationship breakdown, parental divorce, bereavement, immigration), and that growth is associated with higher socio-economic status, higher education, younger age, personality traits such as optimism and extraversion, positive emotions, social support, and problem focused, acceptance, and positive reinterpretation coping. More recently, Helgeson et al. (2006) conducted a meta-analytic review of 87 studies, concluding that benefit finding was related to lower depression and higher wellbeing, but also greater severity of intrusive and avoidant posttraumatic experiences. This latter finding has caused some confusion, leading some to question the adaptive utility of growth, while others propose that posttraumatic stress symptoms should be viewed as signs of the cognitive processes that give rise to growth. Evidence from the Stanford Internet survey following 9/11 (Butler et al., 2005) indicated that there might be a curvilinear relation between levels of posttraumatic stress and positive change, suggesting that there may be a range of traumatic experience most conducive to growth.
Janoff-Bulman's (1992) shattered assumptions theory was developed prior to the establishment of the field but has provided the fundamental theoretical architecture for the two main theories of positive change, notably the transformational model (Tedeschi & Calhoun, 2004) and the organismic valuing theory (Joseph & Linley, 2005). Organismic valuing theory attempts to provide an account of positive changes rooted in humanistic psychology wherein posttraumatic stress is viewed as indicative of normal, natural cognitive processes that have the potential to generate positive change. Theoretically, the largest challenge facing the field over the coming years is whether it succeeds in providing a useful alternative nonmedical paradigm for the study of traumatic stress.
The empirical literature has been limited by an over-reliance on cross-sectional studies, but increasingly longitudinal studies are available and beginning to paint a clearer picture of which factors lead to positive change. For example, in a study of 206 long-term cancer survivors (Schroevers, Helgeson, Sanderman, & Ranchor, 2010), the more emotional support was received at 3 months after diagnosis, the greater was the experience of positive consequences of the illness at 8 years after diagnosis, even when controlling for concurrent levels of emotional support at that follow-up.
Of interest is whether positive changes lead to better outcomes on other more-traditional indices. Linley, Joseph, and Goodfellow (2008) found that people who report positive change are less likely to experience problems of posttraumatic stress at six months. Frazier et al. (2004) asked 171 rape survivors to complete a specially designed questionnaire to measure positive changes at 2 weeks following the assault, and then again 2, 6, and 12 months later. This well-designed study allowed the investigators to see how positive changes related to well-being over time. Four groups were created: (1) those who reported low levels of positive change at 2 weeks and high levels at 12 months ("gained positive change" group); (2) those who reported high levels of positive change at 2 weeks and low levels at 12 months ("lost positive change" group); (3) those who reported low levels at both time points ("never had positive change" group), and (4) those who reported high levels at both time points ("always had positive change" group). Results indicated that those in the "always had positive change" group did the best, showing the lowest levels of depression and posttraumatic stress.
Affleck, Tennen, Croog, and Levine (1987) reported that heart attack patients who found benefits immediately after their first attack had reduced re-occurrence and morbidity statistics eight years later. Turning to biological markers, Epel, McEwen, and Ickovics (1998) found that high levels of positive change were related to lowered cortisol levels in women exposed to laboratory stress, as did Cruess et al. (2000) who reported lower cortisol levels through the enhancement of benefit finding among women with breast cancer. Dunigan, Carr, and Steel (2007) reported that among patients with hepatoma, those scoring high on positive change survived 186 days longer than their lower-scoring peers, due to higher peripheral blood leukocytes. Furthermore, Bower et al. (1998) reported that lower AIDS-related mortality was associated with self-reported benefit finding among bereaved HIV-positive men. Milam (2004) also reported greater immune system functioning among HIV patients with higher levels of positive change.
Issues, Controversies, and Directions
Research has progressed considerably with the introduction of standardized self-report instruments to assess positive change, allowing comparisons to be made between studies, but there is still no consensus regarding the parameters that define the universe of positive change. The most widely used of the measures is the Posttraumatic Growth Inventory (PTGI), which assesses five domains: (1) perceived changes in self (becoming stronger, more confident); (2) developing closer relationships with family, friends, neighbours, fellow trauma survivors, and even strangers; (3) changing life philosophy/increased existential awareness; (4) changed priorities; and (5) enhanced spiritual beliefs. As research has continued to develop and mix in-depth qualitative analysis into the inquiry, many aspects of positive change appear to be absent from the current scales of measurement, suggesting the need to use multiple measures, to recognize that change can be in both positive and negative schematic directions, and to include study-specific measurement.
One of the main current criticisms is the overreliance on retrospective self-report, with some questioning the validity of the concept itself. However, evidence for positive change arises when beforeand- after measures are used. A fortuitous study by Peterson and Seligman (2003) had 4817 respondents complete the on-line Values in Action Classification of Strengths prior to September 11. When scores for individuals who completed the survey in the 2 months immediately after September 11 were compared with the scores for those who completed the survey before September 11, seven character strengths showed increases: gratitude, hope, kindness, leadership, love, spirituality, and teamwork. So, while the use of retrospective self-report is limited, the notion of positive change when measured through other means seems substantiated.
One of the issues that makes measurement so problematic is that the various measures of positive change ask respondents to rate their perceptions of how much they have changed as a result of the event. Ford, Tennen, and Albert (2008) described the complex cognitive operations required of respondents, all of which can be subject to bias. Data on the validity of these retrospective selfreports was questioned by Patricia Frazier and her colleagues (2009) who asked over 1500 students in an on-line survey to complete a battery of questionnaires, including a measure of psychological well-being. Eight weeks later they were asked to complete the questionnaires again and report whether they had experienced any major life events in the interim. Ten percent of the sample reported the experience of a traumatic event in the preceding eight weeks, and increases in psychological well-being were noted when the measure of psychological well-being after the event was compared with that completed before the event. But ratings of how people thought they had changed did not correspond well to these actual changes. A further complication when considering the validity of self-report is the suggestion that some reports of positive change are illusory, such as those that are fleeting or due to positive reporting biases or wishful, defensive, or even superstitious thinking. While illusory change should not be considered as real positive change, most commentators agree that a certain amount of illusory positive reappraisal coping can be psychologically helpful.
Methodologically, the bulk of the research to date is cross-sectional and high-quality longitudinal studies remain relatively rare, and it cannot yet be concluded what factors are predictive of positive change. It is likely, given the example of the wider trauma literature, that there are complex interactions among demographic, personality, coping, and social support variables, such that the effects of one variable are only found at certain levels of other variables. Of note, one prospective study examining reactions to the SARS epidemic among a sample of Chinese who had recovered from the illness, their family members, and other healthy adults living in Hong Kong (Cheng, Wong, & Tsang, 2006) found those who reported "mixed" accounts (accounts that included both benefits and costs to the experience) fared better over the longer term than those reporting exclusively positive or exclusively negative experiences, suggesting that enduring positive change may involve the development of a complex, balanced, and realistic understanding of the experience.
As well as more sophisticated interactional research, there is a need for longitudinal research in order to test the relation of proposed predictive factors with subsequent reports of positive change. Directionality is an issue that deserves further attention, as positive changes might be as likely to lead to increases in many of the factors that have been posited as predictors.
One common misunderstanding is the expectation that those who report positive changes should be free of distress, but this is neither what the evidence suggests nor how researchers in the field understand positive change. Positive changes refer to the eudaimonic rather than the hedonic side of well-being (Joseph & Linley, 2005). Whereas the hedonic approach focuses on emotions, the eudaimonic approach is derived from Aristotelian philosophy and is concerned with the optimal functioning and development of the person. In current positive psychology terminology, the eudaimonic approach refers to psychological well-being (PWB) as opposed to subjective well-being (SWB). SWB refers to people's affective states, the balance between their positive and negative feelings, and the extent to which they are satisfied with life. In contrast, PWB is concerned with the more existential side of life - autonomy, mastery, personal growth, positive relations with others, self-acceptance and purpose in life. Moreover, growth cannot undo what has happened; neither is it necessarily psychologically pervasive. Experiences of positive change may be domain-specific, and distress and growth may co-exist - a condition often observed clinically in those who have suffered a significant loss. As such, theorists argue that positive changes are of value in themselves and that facilitation of growth is a worthwhile clinical outcome in its own right and not simply to be valued in relation to how well positive changes predict lower distress. Advice for therapists is available (Calhoun & Tedeschi, 1999).
Group interventions have been shown to be effective. Antoni et al. (2001) tested the effects of a 10-week group cognitive-behavioral stress management intervention among 100 women newly treated for Stage 0-II breast cancer. The intervention increased participants' reports that breast cancer had made positive contributions to their lives, and it increased generalized optimism at a 3-month followup. While such results are encouraging, caution is still warranted in terms of whether and how this research can be applied in the real world (Lechner, Stoelb, & Antoni, 2008). The topic opens up debate on the ethics of the therapeutic process. Researchers and clinicians are urged to be wary of the potential for patients to experience a tyranny of positive thinking wherein they feel that they must inhibit expression of their concerns and distress and forgo psychotherapeutic work in an effort to remain "positive." Professionals should also consider carefully the moral issues associated with interventions deliberately aimed at helping patients find benefits, as opposed to non-directive interventions that work only with clients' growth when it spontaneously occurs.
↩ Return to top
1c). Attributing Growth to a Traumatic Experience (Coyne, & Tennen, 2010, pp. 23-24).
Even if people were not burdened by the recall problems documented repeatedly in studies of perceived personal change and relationship change, to complete current measures of PTG they would need to accurately determine how much change can be attributed to the traumatic event itself. In other words, people must be able to accurately judge co-variation between the event and subsequent personal changes. A good deal of evidence demonstrates how judgments of co-variation are biased through illusory correlation , whereby the individual who expects a relationship between the two variables tends to overestimate the magnitude of any relation that might exist or even infers a relation when none exists.
Consider a participant in one of the many published studies of PTG among women with breast cancer. The participant is asked to rate the growth she experienced from the cancer experience. To accurately convey the amount of growth that occurred for each scale item, the respondent must first compare herself in the present with how she recalls being on that dimension prior to her cancer diagnosis and then estimate how much of that difference is due to the cancer experience rather than to a secular trend, a developmental change, or a process unrelated to her illness. But, the psychological literature makes clear that people deprecate their past selves to enhance themselves in the present, and they exaggerate in retrospect the stressfulness of life encounters as a way to enhance their current selves. Schacter  provides convincing evidence to support his conclusion that "[e]xaggerating the difficulty of past experiences is another way people enhance [their current status]" (p. 152).
Even among those relatively few people with near-perfect recall and no motivational impetus, the challenge of detecting and recalling trauma-related change, i.e., change that takes into account developmental trajectories unrelated to any particular event, is formidable, and positive psychology's measures of PTG and benefit finding are not exceptions to the rather overwhelming evidence. Psychological science has known for a half century  that people cannot combine the complex information required to judge that personal growth has occurred in response to a threatening encounter, and many investigations over many years have documented the significant limitations in people's capacity to recall personal change. We must conclude that positive psychology researchers are either unaware of the rich and broad psychological science that is at odds with their measurement tools or that they have decided, contrary to their public assertions, to ignore the science.
A recent study  has now tested directly the validity of self-reported post-traumatic growth by assessing prospectively the relation between the measurement of posttraumatic growth as advocated by positive psychology investigators and actual growth from pre- to post-trauma. In this study, more than 1,500 young adults completed measures of the post-traumatic domains measured by the Post-traumatic Growth Inventory (PTGI)  on two occasions separated by 2 months. They also completed the PTGI on the second occasion. One hundred twenty-two of the participants were selected for further study because they reported experiencing a traumatic event during the 2 months. Nearly 75% of these events were rated by the participants as causing intense fear, helplessness, or horror, which is part of the definition of a traumatic event in the DSM-IV .
Frazier and colleagues compared actual change in the PTGI domains to scores on the PTGI among participants who reported a traumatic event during the time between the two assessments. PTGI scores were by and large unrelated to actual growth in PTG-related domains. Moreover, growth measured with the PTGI was associated with increased distress from preto post-trauma, whereas actual growth was related to decreased distress. Finally, PTGI measured growth, but not actual growth was strongly related to positive reinterpretation coping. Based on these findings, the authors conclude "[t]hus, the PTGI and perhaps other retrospective measures [of PTG] do not appear to measure actual pre- to posttrauma change" (p. 912). Most recently, Yanez, Stanton, Hoyt, Tennen, and Lechner  replicated these troubling findings and offered preliminary evidence for their underlying mechanisms.
We are at a loss to explain why positive psychology investigators continue to endorse the flawed conceptualization and measurement of personal growth following adversity. Despite Peterson's  warning that the credibility of positive psychology's claim to science demands close attention to the evidence, post-traumatic growth-a construct that has now generated hundreds of articles-continues to be studied with flawed methods and a disregard for the evidence generated by psychological science. It is this same pattern of disregard that has encouraged extravagant claims regarding the health benefits of positive psychological states among individuals living with cancer.
We want to be clear that we are not asserting that people cannot grow from confronting life's slings and arrows, including serious illness and other health challenges. Of course, positive psychology has no corner on the concept of post-traumatic growth, which has been alluded to by philosophers, playwrights, novelists, theologians, and more recently, icons of the popular culture. What positive psychology potentially has to offer the concept of posttraumatic growth is scientific scrutiny through careful measurement, sensitive study designs, an attitude that propels investigators to seek facts that will disconfirm positive psychology's elegant hypotheses, and careful attention to credible evidence. It is here, in the science- which ostensibly distinguishes the current version of positive psychology from its predecessors-that positive psychology has failed, quite miserably we believe, in its approach to examining growth following adversity.
↩ Return to top
Affleck, G., & Tennen, H. (1996). Construing benefits from adversity: Adaptational significance and dispositional underpinnings. Journal of Personality, 64(4), 899-922. doi:10.1111/j.1467-6494.1996.tb00948.x ABSTRACT The discovery of benefits from living with adversity has been implicated in psychological well-being in numerous investigations, is pivotal to several prominent theories of cognitive adaptation to threat, and can be predicted by personality differences. This article summarizes the prevalence and adaptive significance of finding benefits from major medical problems, locates the place of benefit-finding in stress and coping theories, and examines how it may be shaped by specific psychological dispositions such as optimism and hope and by broader personality traits such as Extraversion and Openness to Experience. The distinction between beliefs about benefits from adversity (benefit-finding) and the use of such knowledge as a deliberate strategy of coping with the problem (benefit-reminding) is underscored and illustrated by daily process research on coping with chronic pain.
Aldwin, C. M. (2007). Stress, coping, and development: An integrative approach (2nd ed.). New York: Guilford Press. We examined three community samples to determine whether stressful episodes form a context for the development of coping resources in adulthood. The first study found that 81.9% of a sample of 845 older men reported drawing upon prior experiences in coping with a recent problem. Content analysis revealed that only 22.7% drew upon similar stressful episodes; the rest drew upon problems from work, the military, illnesses, deaths, etc. The second study replicated the earlier findings in 102 men and women, ages 24 to 84, who reported on a recent low point in semistructured interviews. In addition, 75% reported long-term effects, equally split between negative, positive, and mixed effects. Those individuals who perceived advantages from the low point were significantly more likely to report positive long-term effects. The third study replicated the findings from the first two studies in a sample of 941 men and women ages 23 to 62. Path analyses showed that coping strategies differentially predicted perceived positive or negative outcomes, which in turn predicted current mastery and depression levels. While the findings are cross-sectional and causality cannot be inferred, they are nonetheless supportive of the effects of stress and coping on personality.
Aldwin, C. M., & Levenson, M. R. (2004). Posttraumatic growth: A developmental perspective. Psychological Inquiry, 15(1), 19-22. Stable URL: http://www.jstor.org/stable/20447195 Abstract: Although investigators Richard G. Tedeschi and Lawrence G. Calhoun in the January 2004 issue of the "Psychological Inquiry" are not the first to discuss post-traumatic growth, they have done much to systematize investigation into the topic, by both their theoretical and empirical work. Few would disagree with their identification of the five major domains of post traumatic growth. Nonetheless, the field is still new and there are a great many questions still unresolved. This commentary focuses on developmental issues about the process by which growth occurs after the experience of traumas and other events. The study of adult development has much to contribute to this discussion, given its major focus on how and why change occurs in adulthood.
Aldwin, C. M., Park, C. L., & Spiro, A., III (Eds.). (2007). Handbook of health psychology and aging. New York: Guilford Press.
Aldwin, C. M., Sutton, K., & Lachman, M. (1996). The development of coping resources in adulthood. Journal of Personality, 64, 837-871. doi:10.1111/j.1467-6494.1996.tb00946.x Data collection on the Normative Aging Study was supported by a FIRST Award (R29-AG07465) from the National Institute on Aging and by two services of the Department of Veterans Affairs (Medical Research and Health Services R&D). The Health and Personality Styles Survey was supported by NIA Grant AGO6038 and the John D. and Catherine T. MacArthur Research Network on Successful Midlife Development; the Davis Longitudinal Study was also supported by the MacArthur Research Network, as well as by Hatch Funds from the University of California, Davis (UCD), Cooperative Extension Service and a UCD New Faculty Research Grant. Portions of this research were presented by the first author in an invited address at the 1994 annual meeting of the American Psychological Association. We would like to thank Gina Chiara, Cory Lewkowicz, Rebecca Parker, Cory Fitzpatrick, and Rael Dornfest for their help in data collection and coding, Leanne Friedman for her help in data analysis, and Michael R. Levenson and an anonymous reviewer for their helpful comments on earlier drafts of this article.
Allemand, M., Gomez, V., & Jackson, J. J. (2010). Personality trait development in midlife: exploring the impact of psychological turning points. European Journal of Ageing, 7(3), 147-155. doi:10.1007/s10433-010-0158-0. This study examined long-term personality trait development in midlife and explored the impact of psychological turning points on personality change. Self-defined psychological turning points reflect major changes in the ways people think or feel about an important part of their life, such as work, family, and beliefs about themselves and about the world. This study used longitudinal data from the Midlife in the US survey to examine personality trait development in adults aged 40-60 years. The Big Five traits were assessed in 1995 and 2005 by means of self-descriptive adjectives. Seven types of self-identified psychological turning points were obtained in 1995. Results indicated relatively high stability with respect to rank-orders and mean-levels of personality traits, and at the same time reliable individual differences in change. This implies that despite the relative stability of personality traits in the overall sample, some individuals show systematic deviations from the sample mean-levels. Psychological turning points in general showed very little influence on personality trait change, although some effects were found for specific types of turning points that warrant further research, such as discovering that a close friend or relative was a much better person than one thought they were.
Almedom, A. (2005). Resilience, hardiness, sense of coherence, and posttraumatic growth: All paths leading to "light at the end of the tunnel"? Journal of Loss and Trauma, 10(3), 253-265. doi:10.1080/15325020590928216. Two questions prompted this targeted review: (a) What are the behavioral and social determinants of individual and/or collective resilience-the capacity to rebound from crisis? and (b) Is the evidence base for related concepts, including hardiness, sense of coherence, and posttraumatic growth consistent? The findings suggest that the theory of salutogenesis, operationalized by the sense of coherence construct, is inclusive of the related concepts of resilience and hardiness. Moreover, it is grounded in robust primary research of cross-cultural relevance. More recent concepts of recovery and posttraumatic growth also contribute to our understanding of resilience. Implications for international humanitarian psychosocial programming are discussed.
Anderson, K. M., Danis, F. S., & Havig, K. (2011). Adult daughters of battered women: Recovery and posttraumatic growth following childhood adversity. Families in Society, 92(2). doi:10.1606/1044-3894.4092. This article details the recovery process, including posttraumatic growth, for 15 adult daughters of battered women. Using qualitative inquiry, participants' recovery was found to involve a cognitive restructuring of childhood misconceptions of themselves, their parents, and the trauma itself. Key to this transformation process, and consequently allowing for posttraumatic growth, was an interwoven process of meaning-making including two specific elements of understanding: the cause and effect of domestic violence and the significance of suffering from such exposure in childhood. Distancing from their parents, education on domestic violence, accessing therapeutic/support services, and having a spiritual connection contributed to enhanced insight and wisdom. Implications include providing professionals with conceptual insights regarding how to identify and support adult daughters' lifelong recovery and growth.
Anderson, W.P., Jr., & Lopez-Baez, S. I. (2008). Measuring growth with the posttraumatic growth inventory. Measurement and Evaluation in Counseling and Development, 40, 215-227. The Posttraumatic Growth Inventory (PTGI; R. G. Tedeschi & L. G. Calhoun, 1996) was used to measure the growth of university students (N = 347). Results were compared with those of trauma studies and indicate that the PTGI is a general measure of growth suitable for future nontrauma studies. Results reflect a minimal relationship between growth and stress.
Armeli, S., Gunthert, K. C., & Cohen, L. H. (2001). Stressor appraisals, coping, and post-event outcomes: The dimensionality and antecedents of stress-related growth. Journal of Social and Clinical Psychology, 20(3), 366-395. doi:10.1521/jscp.20.3.366.22304 This study evaluated the dimensionality and the appraisal and coping antecedents of stress-related growth. We surveyed university alumni (N = 447) and college students (N = 472) about their most stressful event in the past two years. Participants reported appraisals of this event and their use of specific coping strategies. To assess growth from this event, we used a revised version of Park, Cohen, and Murch's (1996) Stress-Related Growth Scale (SRGS). Results from confirmatory factor analyses in both samples indicated that the revised SRGS should be regarded as a multidimensional instrument. Next, we used cluster analysis to identify event profiles based on appraisal and coping reports, and then compared these profiles on reports of growth. In both samples, stress-related growth was highest for individuals who reported highly stressful events, for which they had adequate coping and support resources and for which they used adaptive coping strategies.
Biswas-Diener, R. (2006). From the equator to the North Pole: A study of character strengths. Journal of Happiness Studies, 7, 293-310. doi:10.1007/s10902-005-3646-8ABSTRACT. Recently, psychologists have begun to shift their research attention to positive topics historically overlooked by the profession. The study of character strengths is a major research interest of positive psychologists. A classification of 24 character strengths, called the Values in Action (VIA) Classification, has recently been developed, and the current study evaluates these character strengths across cultures. Among 123 members of the Kenyan Maasai, 71 Inughuit in Northern Greenland, and 519 University of Illinois students, we found high rates of agreement about the existence, desirability, and development of these strengths of character. Despite these strong similarities, there were differences between and within cultures in terms of gender, the perceived importance of specific strengths (such as modesty), and the existence of cultural institutions that promote each strength.
Biswas-Diener, R. (2009). Personal coaching as a positive intervention. Journal of Clinical Psychology, 65(5), 544-553. doi:10.1002/jclp.20589 Personal coaching is a relatively new and unlicensed profession aimed at helping functioning individuals set and achieve goals, overcome obstacles, and maintain motivation. Coaching is increasingly merging with psychology as evidenced by new journals, academic programs, and research symposia. Although coaching has traditionally been used with non-clinical populations, it can be highly relevant to psychotherapy. Clinicians who develop a hybrid psychotherapy-coaching practice might be better protected from occupational stress and burnout. In addition, a number of coaching interventions and assessments might translate well to therapy and help clinicians innovate their practice. The synergy between personal coaching and psychotherapy are illustrated with a case example.
Biswas-Diener, R., & Dean, B. (2006). Positive psychology coaching: Putting the science of happiness to work for your clients. Hoboken, NJ: Wiley.
Biswas-Diener, R., Kashdan, T. & King, L. (2009). Two traditions of happiness research, not two distinct types of happiness. Journal of Positive Psychology, 4(3), 208-211. doi:10.1080/17439760902844400 In an earlier paper (Kashdan, Biswas-Diener, & King, 2008), we outlined a critique of the distinction being made between eudaimonic and hedonic forms of happiness. That paper seems to have had the desired effect in stimulating discourse on this important subject as evidenced by a number of responses from our colleagues. In this paper, we address these responses collectively. In particular, we outline common intellectual ground with the responding authors as well as points of difference.
Biswas-Diener, R., Kashdan, T., & Minhas, G. (2011). A dynamic approach to psychological strength development and intervention. The Journal of Positive Psychology, 6(2), 106-118. doi:10.1080/17439760.2010.545429 Many practitioners working with clients from a strengths perspective largely rely on ad hoc interventions and employ a simplistic 'identify and use' approach. In this article, we suggest that clients can extract greater benefits when practitioners adopt more sophisticated approaches to strengths intervention. We introduce an alternative approach that we call 'strengths development'. This approach is distinguished by the view that strengths are not fixed traits across settings and time (the dominant, contemporary approach to personality). Instead, we adopt dynamic, within-person approaches from personality science to research, assessment, and interventions on strengths. Specifically, strengths are highly contextual phenomena that emerge in distinctive patterns alongside particular goals, interests, values, and situational factors. Strengths are potentials for excellence that can be cultivated through enhanced awareness, accessibility, and effort. Finally, we outline potential psychological risks associated with the strengths perspective that are worthy of explicit discussion with clients.
Boals, A., Steward, J., & Schuettler, D. (2010). Advancing our understanding of posttraumatic growth by considering event centrality. Journal of Loss & Trauma, 15(6), 518-533. doi:10.1080/15325024.2010.519271 Research on posttraumatic growth (PTG) has been plagued by inconsistencies and small effect sizes. We hypothesized that relationships between PTG and other psychological variables would become stronger and more consistent with expectations when we limited analyses to only adverse events construed as central to one's identity. The results supported the hypothesis. Comparing our results to those from a recent meta-analysis on PTG, the relationships between PTG, depression, and positive affect were stronger when examining only events central to identity. Additionally, previously nonsignificant correlations with anxiety, global distress, and physical health became significant in the expected directions. Lastly, a formerly puzzling positive correlation between PTG and posttraumatic stress disorder (PTSD) symptoms became nonsignificant. In stark contrast, limiting analyses to only events meeting the DSM-IV A1 criterion did not produce similar results. Future PTG studies should exclude events that fail to cause disruption in respondents' core beliefs to better separate coping behaviors from PTG.
Bonanno, G.A. (2004) Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20-28 doi:10.1037/0003-066X.59.1.20 Many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. Unfortunately, because much of psychology's knowledge about how adults cope with loss or trauma has come from individuals who sought treatment or exhibited great distress, loss and trauma theorists have often viewed this type of resilience as either rare or pathological. The author challenges these assumptions by reviewing evidence that resilience represents a distinct trajectory from the process of recovery, that resilience in the face of loss or potential trauma is more common than is often believed, and that there are multiple and sometimes unexpected pathways to resilience.
Bonanno, G. A. (2005). Clarifying and extending the construct of adult resilience. American Psychologist, 60, 265-267. doi:10.1037/0003-066X.60.3.265b In this article the author responds to comments made in this issue responding to his original article entitled Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? The author notes that in his original article he focused on three crucial points: Resilience among adults represents a distinct and empirically separable outcome trajectory from that normally associated with recovery from trauma; resilience is more prevalent than generally accepted in either the lay or professional literature; and there are multiple and sometimes unexpected factors that inform adult resilience. Owing to the brevity of the article, the author could only touch briefly on many of the more nuanced and complex issues suggested by the resilience construct; this left plenty of room for critique. Fortunately, the comments are generous and insightful and for the most part compatible with the driving goal of the article. As might be expected, of course, there were statements peppered throughout the comments that the author deemed worthy of rebuttal or correction. He considers four points that seemed to beg most urgently for response.
Bonanno, G. A. (2005). Resilience in the face of potential trauma. Current Directions in Psychological Science, 14(3), 135-138. Until recently, resilience among adults exposed to potentially traumatic events was thought to occur rarely and in either pathological or exceptionally healthy individuals. Recent research indicates, however, that the most common reaction among adults exposed to such events is a relatively stable pattern of healthy functioning coupled with the enduring capacity for positive emotion and generative experiences. A surprising finding is that there is no single resilient type. Rather, there appear to be multiple and sometimes unexpected ways to be resilient, and sometimes resilience is achieved by means that are not fully adaptive under normal circumstances. For example, people who characteristically use self-enhancing biases often incur social liabilities but show resilient outcomes when confronted with extreme adversity. Directions for further research are considered.
Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2007). What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. Journal of consulting and clinical psychology, 75(5), 671-82. doi:10.1037/0022-006X.75.5.671. A growing body of evidence suggests that most adults exposed to potentially traumatic events are resilient. However, research on the factors that may promote or deter adult resilience has been limited. This study examined patterns of association between resilience and various sociocontextual factors. The authors used data from a random-digit-dial phone survey (N = 2,752) conducted in the New York City area after the September 11, 2001, terrorist attack. Resilience was defined as having 1 or 0 posttraumatic stress disorder symptoms and as being associated with low levels of depression and substance use. Multivariate analyses indicated that the prevalence of resilience was uniquely predicted by participant gender, age, race/ethnicity, education, level of trauma exposure, income change, social support, frequency of chronic disease, and recent and past life stressors. Implications for future research and intervention are discussed.
Bonanno, G.A., & Kaltman, S. (1999). Toward an integrative perspective on bereavement. Psychological Bulletin, 125(6), 760-776. doi:10.1037/0033-2909.125.6.760 For nearly a century, bereavement theorists have assumed that recovery from loss requires a period of grief work in which the ultimate goal is the severing of the attachment bond to the deceased. Reviews appearing in the 1980s noted a surprising absence of empirical support for this view, thus leaving the bereavement field without a guiding theoretical base. In this article, the authors consider alternative perspectives on bereavement that are based on cognitive stress theory, attachment theory, the social-functional account of emotion, and trauma theory. They then elaborate on the most promising features of each theory in an attempt to develop an integrative framework to guide future research. The authors elucidate 4 fundamental components of the grieving process—context, meaning, representations of the lost relationship, and coping and emotion-regulation processes—and suggest ways in which these components may interact over the course of bereavement.
Bonanno, G. A., Westphal, M., & Mancini, A. D. (2011). Resilience to loss and potential trauma. Annual Review of Clinical Psychology, 7(1), 511-535. Retrieved from http://www.annualreviews.org/doi/abs/10.1146/annurev-clinpsy-032210-104526. Initial research on loss and potentially traumatic events (PTEs) has been dominated by either a psychopathological approach emphasizing individual dysfunction or an event approach emphasizing average differences between exposed and nonexposed groups. We consider the limitations of these approaches and review more recent research that has focused on the heterogeneity of outcomes following aversive events. Using both traditional analytic tools and sophisticated latent trajectory modeling, this research has identified a set of prototypical outcome patterns. Typically, the most common outcome following PTEs is a stable trajectory of healthy functioning or resilience. We review research showing that resilience is not the result of a few dominant factors, but rather that there are multiple independent predictors of resilient outcomes. Finally, we critically evaluate the question of whether resilience-building interventions can actually make people more resilient, and we close with suggestions for future research on resilience.
Bonanno, G.A., Wortman, C.B., Lehman, D.R., Tweed, R.G., Haring, M., Sonnega, J., Carr, D., & Nesse, R.M. (2002). Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology, 83(5), 1150-1164. doi:10.1037/0022-35184.108.40.2060 Abstract The vast majority of bereavement research is conducted after a loss has occurred. Thus, knowledge of the divergent trajectories of grieving or their antecedent predictors is lacking. This study gathered prospective data on 205 individuals several years prior to the death of their spouse and at 6- and 18-mo postloss. Five core bereavement patterns were identified: common grief, chronic grief, chronic depression, improvement during bereavement, and resilience. Common grief was relatively infrequent, and the resilient pattern most frequent. The authors tested key hypotheses in the literature pertaining to chronic grief and resilience by identifying the preloss predictors of each pattern. Chronic grief was associated with preloss dependency and resilience with preloss acceptance of death and belief in a just world.
Borja, S. E., Callahan, J. L., & Rambo, P. L. (2009). Understanding negative outcomes following traumatic exposure: The roles of neuroticism and social support. Psychological Trauma: Theory, Research, Practice, and Policy, 1(2), 118-129. doi:10.1037/a0016011. The established literature indicates that an overwhelming majority of adults will experience at least 1 traumatic stressor during their lifetime. Such stressors have been consistently linked to a range of adverse subsequent conditions and span the mood, anxiety, and personality diagnostic categories. Yet, understanding why some individuals experience traumatic reactions and adverse outcomes and others facing significant stressors do not succumb to such problems remains a challenge. In this study, trauma-exposed participants (natural disaster, n = 51; sexual assault, n = 35) completed measures of neuroticism and social support as well as measures of adverse mental health outcomes known to be associated with traumatic exposure. Results indicate that the personality characteristic of neuroticism is generally significantly correlated with symptoms of posttraumatic stress disorder, depression, and general distress. Social support was found to have no impact alone but a differential impact on these outcomes (sometimes helpful, sometimes harmful) depending on the survivor's level of neuroticism. In considering social support options following traumatic exposure, providers are therefore encouraged to carefully consider the survivor's neurotic demeanor.
Boyraz, G., & Efstathiou, N. (2011). Self-Focused attention, meaning, and posttraumatic growth: The mediating role of positive and negative affect for bereaved women. Journal of Loss & Trauma, 16(1), 13-32. doi:10.1080/15325024.2010.507658 This study examined the mediating impact of positive and negative affect on the relationship between two distinct self-focusing tendencies (i.e., reflection and rumination) and meaning and posttraumatic growth among bereaved women. Supporting the study hypotheses, positive affect mediated the relationship between self-focusing tendencies and both meaning and posttraumatic growth. Reflection and rumination also had indirect effects on meaning through negative affect. The study model accounted for 25% of the variance in positive affect, 31% of the variance in negative affect, 43% of the variance in PTG, and 58% of the variance in meaning. These findings underlined the importance of intellectual self-reflection and positive affect in fostering personal growth and adjustment of bereaved women. Results and implications of the findings are discussed in the light of existing literature on bereavement and self-focusing tendencies.
Burt, M. R., & Katz, B. L. (1987). Dimensions of recovery from rape: Focus on growth outcomes. Journal of Interpersonal Violence, 2, 57-81. doi:10.1177/088626087002001004 The authors attempted to conceptualize and measure how women grow as a consequence of having to cope with rape and its aftermath. Factor analyses of measures completed by 113 rape victims yielded six dimensions of self-concept, five dimensions of coping techniques, and three dimensions of self-ascribed change.
Butler, L. D. (2007). Growing pains: Commentary on the field of posttraumatic growth and Hobfoll and colleagues? Recent contributions to it. Applied Psychology, 56(3), 367-378. doi:10.1111/j.1464-0597.2007.00293.x The field of research on benefit-finding and growth following traumatic experience lacks consensus with respect to some central conceptual questions, and a number of these issues are apparent in the research reported by Stevan Hobfoll and his colleagues. In this commentary I briefly discuss, and at times dispute, some of the assertions and assumptions in this target article that I believe reflect these broader issues, including that: psychosocial gains (or benefits) and psychological growth are equivalent, reporting gains (or benefits) represents maladaptive efforts at coping, posttraumatic growth (PTG) is necessarily linked with positive psychological adjustment, and trauma symptoms represent poor adjustment following traumatic event exposure. I also discuss the intriguing proposal of this research: that action is essential to true growth.
Butler, L. D., Blasey, C. M., Garlan, R. W., McCaslin, S. E., Azarow, J., Chen, X., et al. (2005). Posttraumatic growth following the terrorist attacks of September 11, 2001. Cognitive, coping and trauma symptom predictors in an internet convenience sample. Traumatology, 11, 247-267. doi:10.1177/153476560501100405 Cognitive, coping, and trauma symptom predictors of posttraumatic growth (PTG; measured with the Post-traumatic Growth Inventory) were examined in a large convenience sample (n =1,505) participating in a longitudinal Internet-based study following the terrorist attacks of 9/11/01. Results indicate that initial PTG levels (mean 9 weeks post-attacks) were generally associated with higher trauma symptoms (measured with the PTSD Checklist-Specific), positive changes in worldview (measured with the Changes in Outlook Questionnaire), more denial, and less behavioral disengagement (measured with the Brief COPE). Additionally, PTG had a curvilinear association with level of trauma symptoms, such that those reporting symptoms at intermediate levels reported the highest levels of growth. Levels of PTG declined somewhat over time with the exception of Spiritual Change. As expected, PTG levels at follow-up (mean 6.5 months post-attacks) were primarily predicted by initial PTG levels; however, decreases from baseline in trauma symptoms and increases from baseline in positive worldview, acceptance, and positive reframing were also associated with higher reported posttraumatic growth at follow-up. These findings suggest that there may be a range of traumatic experience most conducive to growth and they also highlight the important contributions of cognitive and coping variables to psychological thriving in short- and longer-term periods following traumatic experience.
Cadell, S., Regehr, C., & Hemsworth, D. (2003). Factors contributing to posttraumatic growth: A proposed structural equation model. American Journal of Orthopsychiatry, 73(3), 279-287. doi:10.1037/0002-94220.127.116.119 With the current shift to include positive outcomes of trauma, this research was designed to explore factors that allow growth to occur. Structural equation modeling was used to test a model for understanding posttraumatic growth. A sample (N = 174) of bereaved HIV/AIDS caregivers completed questionnaires. Spirituality, social support, and stressors were found to have a positive relationship with growth. Facilitation of posttraumatic growth is crucial to all helping professions.
Calhoun, L. G., Cann, A., Tedeschi, R. G., & McMillan, J. (2000). A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing. Journal of Traumatic Stress, 13(3), 521-527. doi:10.1023/A:1007745627077 The present study examined the degree to which event related rumination, a quest orientation to religion, and religious involvement is related to posttraumatic growth. Fifty-four young adults, selected based on prescreening for experience of a traumatic event, completed a measure of event related ruminations, the Quest Scale, an index of religious participation, and the Posttraumatic Growth Inventory. The three subscales of the Quest Scale, the two groups of rumination items (soon after event/within past two weeks), and the index of religious participation were entered in a standard multiple regression with the total score of the Posttraumatic Growth Inventory as the dependent variable. The degree of rumination soon after the event and the degree of openness to religious change were significantly related to Posttraumatic Growth. Congruent with theoretical predictions, more rumination soon after the event, and greater openness to religious change were related to more posttraumatic growth. Present findings offer some confirmation of theoretical predictions, and also offer clear direction for further research on the relationships of religion, rumination, and posttraumatic growth.
Calhoun, L. G., & Tedeschi, R. G. (1998). Beyond recovery from trauma: Implications for clinical practice and research. Journal of Social Issues, 54(2), 357-371. doi:10.1111/j.1540-4560.1998.tb01223.x This article draws implications for clinicians working with survivors of major life crises in four general areas: the relation of psychological well-being, distress, and posttraumatic growth; conceptual issues in this type of clinical work; the process of encouraging growth in clients following traumatic events; and suggestions for additional research. Posttraumatic growth can be accompanied by an increase in well-being, but distress and growth may also coexist. Positive changes can occur in several domains, but many are likely to be phenomenological. Degree of change produced by clinical intervention may be limited in scope, but there clearly are some ways in which the clinician may make growth more likely for the client. Suggestions for future research include the call for longitudinal investigations, studies of rumination and responses of the social network, and the examination of potential gender differences in posttraumatic growth.
Calhoun, L. G., & Tedeschi, R. G. (1999). Facilitating posttraumatic growth: A clinician's guide. Mahwah, NJ: Erlbaum. The authors provide a framework for clinical efforts to enhance posttraumatic growth. Chapters provide case examples, clinical approaches, and resources for both clinicians and clients.
Calhoun, L. G., & Tedeschi, R. G. (2001). Posttraumatic growth: The positive lessons of loss. In R. A. Neimeyer, (Ed), Meaning reconstruction & the experience of loss, (pp. 157-172). Washington, DC: American Psychological Association. doi:10.1037/10397-008 Presents a wide-ranging review of the substantial empirical literature that provides evidence of personal growth resulting from a struggle with loss, for at least a stable minority of those who suffer it. Processes addressed include factors such as individual differences, the magnitude of the trauma and the growth processes facilitating a changed sense of self, changed relationships, existential and spiritual growth. The authors go on to develop not only a research agenda for future investigations, but also some preliminary guidelines for practicing clinicians engaged with their clients in an effort after meaning.
Calhoun, L. G. & Tedeschi, R. G. (2004) The foundations of posttraumatic growth: New considerations, Psychological Inquiry, 15(1), 93-102 doi:10.1207/s15327965pli1501_03 In response to comments on our model of posttraumatic growth, we consider the validity of reports of posttraumatic growth, appropriate methodology to use to assess posttraumatic growth, and its relation with other variables that appear to bear a resemblance to posttraumatic growth (e.g., well-being and psychological adjustment). The potentially important role of proximate and distal cultural factors is also addressed. Clinicians are encouraged to use interventions that facilitate posttraumatic growth with care, so as not to create expectations for posttraumatic growth in all trauma survivors, and to instead promote a respect for the difficulty of trauma recovery while allowing for the exploration of possibilities for various kinds of growth even in those who have suffered greatly.
Calhoun, L. G. & Tedeschi, R. G. (2008). The paradox of struggling with trauma: Guidelines for practice and directions for research. In S. Joseph & P. A. Linley (Eds.), Trauma, recovery, and growth: Positive psychological perspectives on posttraumatic stress (pp. 325-337). Hoboken, NJ: Wiley.
Calhoun, L., Tedeschi, R., & Cann, A. (2010). Positive outcomes following bereavement: Paths to posttraumatic growth. Psychologica Belgica, 50(1&2), 125-143. Recent theory and research have drawn attention to the need to better understand the positive changes, termed posttraumatic growth, that often occur in bereaved individuals; even as negative emotions related to grief persist. We describe five dimensions of posttraumatic growth and present a model for understanding how the loss of a close other can eventually lead to a recognition of important positive personal changes. Loss, especially unexpected loss, disrupts an individual's beliefs about the world and initiates a process of rebuilding an understanding. During this process, many people come to realise their own strengths, appreciate the impact of their relationships, and have new spiritual insights. A strategy for facilitating growth during clinical work also is described.
Campbell, W. K., Brunch, A. B. & Foster, J. D.(2004). Sitting here in limbo: Ego shock and posttraumatic growth. Psychological Inquiry, 15(1), 22-26. Abstract: In their target article in the January 2004 issue of "Psychological Inquiry," investigators Richard G. Tedeschi and Lawrence G. Calhoun bring together literature from a variety of fields to highlight the personal growth that can occur after a range of traumatic experiences. The authors do an excellent job of documenting examples of post-traumatic growth and describing some of the cognitive and interpersonal processes that drive this growth. The article offers an optimistic picture of the individual response to trauma. This counters a long tradition in psychology of highlighting the importance of psychologically defending the self against threat. The authors offer a compelling portrait of the narrative self-reconstruction processes that leads to post-traumatic growth.
Cann, A., Calhoun, L., Tedeschi, R., Taku, K., Vishnevsky, T., Triplett, K., & Danhauer, S. (2010). A short form of the Posttraumatic Growth Inventory. Anxiety, Stress & Coping, 23(2), 127-137. doi:10.1080/10615800903094273 A short form of the Posttraumatic Growth Inventory (PTGI-SF) is described. A sample of 1351 adults who had completed the Posttraumatic Growth Inventory (PTGI) in previous studies provided the basis for item selection. The resulting 10-item form includes two items from each of the five subscales of the original PTGI, selected on the basis of loadings on the original factors and breadth of item content. A separate sample of 186 completed the short form of the scale (PTGISF). Confirmatory factor analyses on both data sets demonstrated a five-factor structure for the PTGI-short form (PTGI-SF) equivalent to that of the PTGI. Three studies of homogenous clinical samples (bereaved parents, intimate partner violence victims, and acute leukemia patients) demonstrated that the PTGI-SF yields relationships with other variables of interest that are equivalent to those found using the original form of the PTGI. A final study demonstrated that administering the 10 short-form items in a random order, rather than in the fixed context of the original scale, did not impact the performance of the PTGI-SF. Overall, these results indicate that the PTGI-SF could be substituted for the PTGI with little loss of information.
Cann, A., Calhoun, L., Tedeschi, R., Triplett, K., Vishnevsky, T., & Lindstrom, C. (2011). Assessing posttraumatic cognitive processes: the Event Related Rumination Inventory. Anxiety, Stress & Coping, 24(2), 137-156. doi:10.1080/10615806.2010.529901 Cognitive processes in the aftermath of experiencing a major life stressor play an important role in the impact of the event on the person. Intrusive thoughts about the event are likely to be associated with continued distress, while deliberate rumination, aimed at understanding and problem-solving, should be predictive of posttraumatic growth (PTG). The Event Related Rumination Inventory (ERRI), designed to measure these two styles of rumination, is described and validation information is provided. Using a college student sample screened for having experienced highly stressful life events, data were obtained (N=323) to conduct an exploratory factor analysis that supported the two factors of the ERRI. Separate confirmatory factor analyses (CFA) on two additional samples (Ns=186 and 400) supported a two-factor model. The two ERRI factors were validated by comparison with related variables and by assessing their contributions to predicting distress and PTG in two samples (Ns=198 and 202) that had been combined to conduct the second CFA. Data indicate the ERRI has solid psychometric properties, captures variance not measured by stable differences in cognitive styles, and the separate factors are related to posttraumatic distress and growth as predicted by existing models of PTG.
Carver, C. S. (1998). Resilience and thriving: Issues, models and linkages. Journal of Social Issues, 54(2), 245-266. doi:10.1111/j.1540-4560.1998.tb01217.x This article addresses distinctions underlying concepts of resilience and thriving and issues in conceptualizing thriving. Thriving (physical or psychological) may reflect decreased reactivity to subsequent stressors, faster recovery from subsequent stressors, or a consistently higher level of functioning. Psychological thriving may reflect gains in skill, knowledge, confidence, or a sense of security in personal relationships. Psychological thriving resembles other instances of growth. It probably does not depend on the occurrence of a discrete traumatic event or longer term trauma, though such events may elicit it. An important question is why some people thrive, whereas others are impaired, given the same event. A potential answer rests on the idea that differences in confidence and mastery are self-perpetuating and self-intensifying. This idea suggests a number of variables whose role in thriving is worth closer study, including personality variables such as optimism, contextual variables such as social support, and situational variables such as the coping reactions elicited by the adverse event.
Carver, C. S., & Connor-Smith, J. (2010). Personality and coping. Annual Review of Psychology, 61, 679-704. doi:10.1146/annurev.psych.093008.100352 Personality psychology addresses views of human nature and individual differences. Biological and goal-based views of human nature provide an especially useful basis for construing coping; the five-factor model of traits adds a useful set of individual differences. Coping-responses to adversity and to the distress that results-is categorized in many ways. Meta-analyses link optimism, extraversion, conscientiousness, and openness to more engagement coping; neuroticism to more disengagement coping; and optimism, conscientiousness, and agreeableness to less disengagement coping. Relations of traits to specific coping responses reveal a more nuanced picture. Several moderators of these associations also emerge: age, stressor severity, and temporal proximity between the coping activity and the coping report. Personality and coping play both independent and interactive roles in influencing physical and mental health. Recommendations are presented for ways future research can expand on the growing understanding of how personality and coping shape adjustment to stress.
Chopko, B. (2010). Posttraumatic distress and growth: An empirical study of police officers. American Journal of Psychotherapy, 64(1), 55-72. Few studies have examined the experience of posttraumatic growth, among police officers following traumatic incidents. Additionally, research examining the relationship between posttraumatic distress (e.g., posttraumatic symptoms) and posttraumatic growth among various populations has been inconsistent. Consistent with the need to gain enhanced understanding in the area of posttraumatic growth, this study investigated the relation between posttraumatic distress (using the Impact of Events Scale-Revised) and posttraumatic growth (using the Posttraumatic Growth Inventory) among 183 police officers. Results of Pearson Correlations showed that posttraumatic distress was significantly and positively related to the Posttraumatic Growth Inventory full-scale and all sub-scale scores. Multiple regression analyses revealed that being involved in a duty-related shooting was the most significant predictor of posttraumatic growth. Implications for mental health providers are discussed.
Christopher, M. (2004). A broader view of trauma: A biopsychosocial-evolutionary view of the role of the traumatic stress response in the emergence of pathology and/or growth. Clinical Psychology Review, 24(1), 75-98. doi:10.1016/j.cpr.2003.12.003 The main goal of this paper is to articulate a biopsychosocial evolutionary approach to understanding the traumatic stress response. The secondary goal of this paper is to draw out the general clinical implications of this approach. I articulate seven interconnected and overlapping empirically grounded theoretical conclusions: (1) Stress is best understood as a prerational form of biopsychological feedback regarding the organism's relationship with its environment; (2) The normal outcome of traumatic stress is growth, rather than pathology; (3) Most psychopathology is a function of the maladaptive modulation of the stress response; (4) Trauma always leaves the individual transformed on a biological, as well as psychological, level; (5) The general biological process underlying stress responses is universal, but the specific dynamics are always a function of the unique sociocultural environment and psychological makeup of the individual; (6) The biology underlying stable psychopathological symptoms may change even as the psychological symptoms remain the same; and (7) Rationality is humanity's evolutionarily newest and most sophisticated stress-reduction behavioral mechanism, and the most important aspect of restoring psychological health to the trauma victim.
Cicchetti, D., & Blender, J. a. (2006). A multiple-levels-of-analysis perspective on resilience: implications for the developing brain, neural plasticity, and preventive interventions. Annals of the New York Academy of Sciences, 1094, 248-58. doi:10.1196/annals.1376.029. Resilient functioning, the attainment of unexpected competence despite significant adversity, is among the most intriguing and adaptive phenomena of human development. Although growing attention has been paid to discovering the processes through which individuals at high risk do not develop maladaptively, the empirical study of resilience has focused predominantly on detecting the psychosocial determinants of the phenomenon. For the field of resilience to grow in ways that are commensurate with the complexity inherent to the construct, efforts to understand underlying processes will be facilitated by the increased implementation of interdisciplinary research designed within a developmental psychopathology framework. Research of this nature would entail a consideration of psychological, biological, and environmental-contextual processes from which pathways to resilience might eventuate (known as equifinality), as well as those that result in diverse outcomes among individuals who have achieved resilient functioning (know as multifinality). The possible relation between the mechanisms of neural plasticity and resilience and specific suggestions concerning research questions needed to examine this association are discussed. Examples from developmental neuroscience and molecular genetics are provided to illustrate the potential of incorporating biology into the study of resilience. The importance of adopting a multiple-levels-of-analysis perspective for designing and evaluating interventions aimed at fostering resilient outcomes in persons facing significant adversity is emphasized.
Cicchetti, D., & Rogosch, F. A. (1997). The role of self-organization in the promotion of resilience in maltreated children. Development and Psychopathology, 9(4), 797-815. Retrieved June 5, 2011, from http://dionysus.psych.wisc.edu/lit/Articles/CicchettiD1997a.pdf. The dynamic nature of resilience necessitates that children from high-risk backgrounds who are functioning adaptively despite experiences of adversity must be examined over time. In the current investigation, the adaptation of school-age maltreated and nonmaltreated socioeconomically disadvantaged children was examined over 3 consecutive years. In accord with predictions, a higher percentage of nonmaltreated children than of maltreated children were found to be resilient. Moreover, a higher percentage of maltreated than of nonmaltreated children were shown to exhibit functioning consistently in the low adaptive range. Differential predictors of resilience were found in maltreated and nonmaltreated children. Specifically, for maltreated children, positive self-esteem, ego resilience, and ego overcontrol predicted resilient functioning, whereas relationship features were more influential for nonmaltreated children. These findings are discussed in relation to the unfolding of resilient self-organizational strivings in maltreated and nonmaltreated children.
Classen, C. C., Pain, C., Field, N. P., & Woods, P. (2006). Posttraumatic personality disorder: a reformulation of complex posttraumatic stress disorder and borderline personality disorder. The Psychiatric Clinics of North America, 29(1), 87-112. doi:10.1016/j.psc.2005.11.001. There is a growing recognition among clinicians who treat individual who are chronically traumatized that the Diagnostic and Statistical Manual, 4th Edition (DSM-IV)  does not provide an adequate diagnostic category to capture the full range of symptomatology with which these individuals frequently present. Borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) often are considered the best diagnostic options. Alone or together, however, these categories do not describe the full range of symptomatology for individuals suffering as a result of chronic traumatization. Furthermore, they do not provide an adequate framework for understanding etiology or how to treat these individuals. New diagnostic categories are needed to better account for the range of symptom constellations that can result from chronic traumatization.
Clay, R., Knibbs, J., & Joseph, S. (2009). Measurement of posttraumatic growth in young people: A review. Clinical Child Psychology & Psychiatry, 14(3), 411-422. doi:10.1177/1359104509104049 The potential of the positive psychology perspective to change the focus of clinical research and practice has become increasingly recognized. A variety of new psychometric instruments informed by positive psychology are now available to mental health clinicians, providing them with tools to assess change across the spectrum of human functioning. One area of research and practice in which this is evident is in posttrauma work, where it is becoming more common to assess posttraumatic growth alongside posttraumatic stress. The majority of work on posttraumatic growth has been with adults, but the last few years have also seen a new body of research with children and adolescents. The aim is to review literature relating to the measurement of growth. It is concluded that several measures with acceptable psychometric properties now exist for the assessment of posttraumatic growth in children and adolescents.
Cohn, M. A., Fredrickson, B. L., Brown, S. L., Mikels, J. A., & Conway, A. M. (2009). Happiness unpacked: Positive emotions increase life satisfaction by building resilience. Emotion, 9(3), 361-368. doi:10.1037/a0015952 Happiness-a composite of life satisfaction, coping resources, and positive emotions-predicts desirable life outcomes in many domains. The broaden-and-build theory suggests that this is because positive emotions help people build lasting resources. To test this hypothesis, the authors measured emotions daily for 1 month in a sample of students (N = 86) and assessed life satisfaction and trait resilience at the beginning and end of the month. Positive emotions predicted increases in both resilience and life satisfaction. Negative emotions had weak or null effects and did not interfere with the benefits of positive emotions. Positive emotions also mediated the relation between baseline and final resilience, but life satisfaction did not. This suggests that it is in-the-moment positive emotions, and not more general positive evaluations of one's life, that form the link between happiness and desirable life outcomes. Change in resilience mediated the relation between positive emotions and increased life satisfaction, suggesting that happy people become more satisfied not simply because they feel better but because they develop resources for living well.
Collins, R., Taylor, S. E., & Skokan, L. A. (1990). A better world or a shattered vision? Changes in perspectives following victimization. Social Cognition, 8, 263-285. doi:10.1521/soco.1918.104.22.1683 Previous research has separately documented positive (Taylor, 1983) and negative (Janoff-Bulman, 1989) changes in beliefs following victimization. An integration of these literatures is proposed, considering the coping responses of the victim, the area of belief examined, and attributes of the victimizing event as mediators of change valence. Fifty-five cancer patients were interviewed concerning changes experienced in self-views, views of the world, future plans, relationships, and activities/priorities following diagnosis. Changes in activities/priorities and relationships were primarily positive, whereas changes in views of the self, the world, and the future were affectively mixed. Active coping was associated with positive belief changes, as was use of multiple coping methods. In addition, respondents experiencing ongoing threat reported more negative changes than did those not under threat. Implications of the findings are discussed.
Connor-Smith JK, Flachsbart C. (2007). Relations between personality and coping: a meta-analysis. Journal of Personality and Social Psychology, 93(6), 1080-1107. doi:10.1037/0022-3522.214.171.1240 Personality may directly facilitate or constrain coping, but relations of personality to coping have been inconsistent across studies, suggesting a need for greater attention to methods and samples. This meta-analysis tested moderators of relations between Big Five personality traits and coping using 2,653 effect sizes drawn from 165 samples and 33,094 participants. Personality was weakly related to broad coping (e.g., Engagement or Disengagement), but all 5 traits predicted specific strategies. Extraversion and Conscientiousness predicted more problem-solving and cognitive restructuring, Neuroticism less. Neuroticism predicted problematic strategies like wishful thinking, withdrawal, and emotion-focused coping but, like Extraversion, also predicted support seeking. Personality more strongly predicted coping in young samples, stressed samples, and samples reporting dispositional rather than situation-specific coping. Daily versus retrospective coping reports and self-selected versus researcher-selected stressors also moderated relations between personality and coping. Cross-cultural differences were present, and ethnically diverse samples showed more protective effects of personality. Richer understanding of the role of personality in the coping process requires assessment of personality facets and specific coping strategies, use of laboratory and daily report studies, and multivariate analyses.
Coyne, J. C., & Gottlieb, B. H. (1996). The mismeasure of coping by checklist. Journal of Personality, 64, 959-991. doi:10.1111/j.1467-6494.1996.tb00950.x Hundreds of studies bave now used standardized checklists to assess respondents' self-reports of coping with naturally occurring stress. This article presents a critical review of the conceptual and methodological issues involved in the use of these checklists. As they are currently employed, conventional checklists render an incomplete and distorted portrait of coping. Specifically, these checklists are grounded in too narrow a conception of coping; the application and interpretation of checklists in the typical study are not faithful to a transactional model of stress and coping; statistical controls cannot eliminate the effects of key person and situation variables on coping; and no consistent interpretation can be assigned to coping scale scores. Researchers are encouraged to consider a broader range of methods for assessing coping, including semistructured interviews, customized checklists tailored to their specific hypotheses and objectives, daily diaries, and traditional trait measures.
Coyne, J.C., & Tennen, H. (2010). Positive psychology in cancer care: Bad science, exaggerated claims, and unproven medicine. Annals of Behavioral Medicine, 39, 16-26. doi:10.1007/s12160-009-9154-z Background Claims of positive psychology about people with cancer enjoy great popularity because they seem to offer scientific confirmation of strongly held cultural beliefs and values. Purpose Our goal is to examine critically four widely accepted claims in the positive psychology literature regarding adaptational outcomes among individuals living with cancer. Methods We examine: (1) the role of positive factors, such as a "fighting spirit" in extending the life of persons with cancer; (2) effects of interventions cultivating positive psychological states on immune functioning and cancer progression and mortality; and evidence concerning (3) benefit finding and (4) post-traumatic growth following serious illness such as cancer and other highly threatening experiences. Results Claims about these areas of research routinely made in the positive psychology literature do not fit with available evidence. We note in particular the incoherence of claims about the adaptational value of benefit finding and post-traumatic growth among cancer patients, and the implausibility of claims that interventions that enhance benefit finding improve the prognosis of cancer patients by strengthening the immune system. Conclusion We urge positive psychologists to rededicate themselves to a positive psychology based on scientific evidence rather than wishful thinking.
Coyne, J.C., Tennen, H., & Ranchor, A.V. (2010). Positive psychology in cancer care: A story line resistant to evidence. Annals of Behavioral Medicine, 39, 35-42. doi:10.1007/s12160-010-9157-9 Background Aspinwall and Tedeschi (Ann Behav Med, 2010) summarize evidence they view as supporting links between positive psychological states, including sense of coherence (SOC) and optimism and health outcomes, and they refer to persistent assumptions that interfere with understanding how positive states predict health. Purpose We critically evaluate Aspinwall and Tedeschi's assertions. Methods We examine evidence related to SOC and optimism in relation to physical health, and revisit proposed processes linking positive psychological states to health outcomes, particularly via the immune system in cancer. Results Aspinwall and Tedeschi's assumptions regarding SOC and optimism are at odds with available evidence. Proposed pathways between positive psychological states and cancer outcomes are not supported by existing data. Aspinwall and Tedeschi's portrayal of persistent interfering assumptions echoes a disregard of precedent in the broader positive psychology literature. Conclusion Positive psychology's interpretations of the literature regarding positive psychological states and cancer outcomes represent a self-perpetuating story line without empirical support.
Davidson, R. J. (2000). Affective style, psychopathology, and resilience: Brain mechanisms and plasticity. American Psychologist, 55(11), 1196-1214. doi:10.1037/0003-066X.55.11.1196. The brain circuitry underlying emotion includes several territories of the prefrontal cortex (PFC), the amygdala, hippocampus, anterior cingulate, and related structures. In general, the PFC represents emotion in the absence of immediately present incentives and thus plays a crucial role in the anticipation of the future affective consequences of action, as well as in the persistence of emotion following the offset of an elicitor. The functions of the other structures in this circuit are also considered. Individual differences in this circuitry are reviewed, with an emphasis on asymmetries within the PFC and activation of the amygdala as 2 key components of affective style. These individual differences are related to both behavioral and biological variables associated with affective style and emotion regulation. Plasticity in this circuitry and its implications for transforming emotion and cultivating positive affect and resilience are considered.
Davis, C. G., & Asliturk, E. (2011). Toward a positive psychology of coping with anticipated events. Canadian Psychology/Psychologie canadienne, 52(2), 101-110. doi:10.1037/a0020177. Many people appear to be quite resilient to significant stress suggesting that they may possess an orientation to events and life that is resistant to such threats. We propose that one significant aspect of this orientation is the tendency to view adversities as something that can happen to anyone and is reflected in the tendency of people entering uncertain contexts to prepare by imagining a range of possible outcomes, both desired and undesired. This preparatory work facilitates the immediate implementation of effective problem solving and support seeking strategies should the desired outcome seem in doubt. We refer to this orientation as the realistic orientation and review evidence suggesting that such an orientation is associated with realistic—but not unrealistic—optimism and smooth adaptation to adversity.
Dekel, R., & Nuttman-Shwartz, O. (2009). Posttraumatic stress and growth: The contribution of cognitive appraisal and sense of belonging to the country. Health and Social Work, 34