Think of a time when you:
overcame a difficult period;
bounced back from a tough situation;
got through a difficult time with relative ease;
challenged yourself, and went out of your ‘comfort zone.’
(Adapted from Reivich and Shatte, 2002)
When it comes to resilience, whom should we be targeting? Children or adults? Vulnerable populations or ‘normal’ functioning populations?
‘That which does not kill us makes us stronger.’ What do you think of Nietzsche’s quote?
What do you think about PTG? Is it real? Does it matter?
How do you intend to ‘age well’?
Stress versus trauma
Prolonged stressful living can cause havoc on physical, emotional, and psychological wellbeing.
However, stress can sometimes be good when offered in small and infrequent doses. Intermittent stress, or tight allostasis, prepares us for future stressors.
Trauma is the ‘unexpected’ event that creates long-lasting problems and substantially interrupts a personal narrative.
When individuals are faced with trauma or unintentional change, there are three proposed psychological responses: (1) Succumbing to the stressor (also referred to as post-traumatic stress disorder or PTSD), (2) resilience and recovery; and (3) posttraumatic growth.
Research shows that only 5% to 35% of individuals succumb to a negative way of thinking after trauma, such as the diagnosis of an illness.
Positive psychology asks: what happens to the other 65% to 95%?
Resilience
Resilience is a multi-definitional construct, defined as flexibility in response to changing situational demands and the ability to bounce back from negative emotional experiences.
Lepore and Revenson (2006) separate resilience into recovery, resistance, and reconfiguration.
Recovery is returning to baseline levels of functioning, resistance is when a person shows no signs of disturbance, and reconfiguration is when people return to homeostasis in a different formation.
This last element of resilience is similar to post-traumatic growth (PTG).
What are the components of resilience?
The components identified as facilitators of resilient individuals include reframing, the experience of positive emotions, participation in physical activity, trusted social support, use of personal and authentic strengths, and optimism.
Risk factors associated with non-resilient individuals include low birth weight, low socio-economic status (SES), low maternal education, and an unstable family structure.
Individuals must change pessimistic thinking patterns and develop an optimistic explanatory style to become more resilient. To do this, individuals must identify which thinking traps they tend to succumb to and construct a more realistic view of adversity.
Research has shown that when faced with a difficult situation, individuals tend to engage in one of several ‘thinking traps,’ such as jumping to conclusions, tunnel vision, magnifying the negative and minimizing the positive, personalizing or externalizing blame, over-generalizing small setbacks, engaging in mind reading, and using unhelpful emotional reasoning.
Resilience and the body
The Holocaust has left survivors and those left behind with tremendous resilience and growth in the face of adversity. Even decades later, survivors from the prison camps show significant physical health functioning (salutogenic) versus illness-inducing (pathogenic) outcomes.
Salutogenesis is linked to a sense of coherence (SOC), developed by Antonovsky (1979) to understand why some people are less likely to be affected by stressful environments than others.
SOC is defined as a global orientation that expresses the extent to which one has a persuasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable, and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; (3) these demands are challenges, worthy of investment and engagement.
Comprehensibility is a person’s insight into their achievement and difficulties, manageability refers to a high probability that things will work out as well as can be reasonably expected, and meaningfulness is the motivational belief that it makes emotional sense to cope.
These components are essential for a successful life. Research suggests that a SOC usually develops by age 30. The more one’s experiences are characterized by these components, the more likely they are to succeed.
The sense of coherence (SOC) concept includes hardiness, self-efficacy, and locus of control.
It has been linked to high associations with wellbeing and life satisfaction, reduced fatigue and loneliness, and negative correlations with anxiety and depression.
Low SOC predicts musculoskeletal symptoms in later life and predicts response to pain-management programs for chronic pain sufferers. It is linked to pain levels in cancer patients and greater difficulty in performing daily activities and general health.
Coping styles
Lazarus and Folkman’s transactional model of stress appraisal is the most widely known and used model within coping research.
Coping is ‘constantly changing cognitive and behavioral efforts to manage specific external or internal demands appraised to be taxing or exceeding the person’s resources.’
There are two main coping strategies that individuals use when faced with stressful or adverse situations: problem-focused coping and emotion-focused coping.
Problem-focused coping is when people identify the stressor and take active steps to engage with and tackle the issues at hand.
Emotion-focused coping is when individuals focus on dealing with the emotions surrounding the situation rather than attempting to change or deal with the situation.
Earlier research posited that problem-focused coping was the better form of coping, but newer research shows that emotion-focused coping can indeed have positive consequences.
For example, avoidance was once seen as a negative coping strategy, but now research shows that engaging in healthy distractions can be beneficial.
The concept of self-sacrifice and suffering for the greater good is a common theme throughout humanity, with Judaeo-Christian religions based on sacrificing one man’s life for all humankind.
Post-traumatic growth (PTG) is a field of study within positive psychology that looks at how, through dealing with (and not the direct result of) trauma, a person can become better and stronger and operate at higher levels of functioning than what existed before the traumatic event occurred.
PTG has been found to exist within samples of survivors from war, grief, breast cancer, mastectomy, bone marrow disease, heart attack, rheumatoid arthritis, spinal cord injury, MS, shipping disaster, tornado, plane crash, rape, childhood sexual assault, incest, shooting, HIV, infertility, chemical dependency, military combat, and bombing.
Post-traumatic growth is divided into five domains: personal strength, relating to others, appreciation for life, new possibilities, and spiritual change.
Personal strength is when trauma survivors report becoming stronger, deeper, more authentic, confident, open, empathetic, creative, more alive, mature, humanitarian, special, humble, and so on.
Relating to others is when people report becoming closer to their immediate and extended families, and friendships bind tighter.
Appreciation for life is when trauma highlights our vulnerability and the fact that we are not invincible and allows us to reflect on deeper issues such as mortality, spirituality, and the meaning of and purpose in life.
New possibilities are when individuals change their life goals, re-enroll in schooling, gain a degree, or obtain new skills.
Spiritual change is when people may return to their previous (or alternative) faith and actively participate in church and pray.
Criticisms of PTG
Some researchers believe that trauma survivors are actually experiencing a form of cognitive dissonance or positive illusion.
Cognitive dissonance is psychological reasoning in which reality is so different from what one believes that to understand, the person rationalizes the occurrence to maintain equilibrium within the psyche.
On the other hand, positive illusions can be good for us, as they create positive illusions about their traumatic situation to rationalize and move on.
These theories postulate that humans must find a reason for it; otherwise, it would be too hard to comprehend.
Critics have come in the form of the tyranny of positive thinking.
People (but not all) can find something beneficial out of their struggle with adversity, which can have a profound positive effect on current trauma survivors.
It must be made clear that not everyone can achieve PTG and that this is OK.
Whether or not PTG is real, the argument appears counterproductive, as it is simply the subjective sense of being better.
If there is no obvious psychopathology and no detriment to anyone, and it appears beneficial on both psychological and physical levels, then researchers within the domain believe it is important to study it in its own right.
Furthermore, if PTG is simply an illusion or a socially desirable bias, the critics have not yet created measurement tools or agreed-upon definitions for identifying illusions or distortions.
What’s the point of it?
Post-traumatic growth (PTG) benefits survivors of traumatic events who experience it in the immediate aftermath of tragedy.
Longitudinal studies have shown that benefit finding after losing a loved one predicted lower levels of distress 13 months later. This has been extended to lower levels of PTSD three years following a traumatic event.
Heart attack patients who found benefits immediately after their first attack had reduced reoccurrence and morbidity statistics eight years after.
Post-traumatic growth and benefit finding do not need to occur only in those that have had seismic, one-off events.
Individuals with arthritis with higher levels of benefit finding were more likely to report lower pain severity and activity limitations.
For terminal patients, those that score higher on PTG measurements have been found to live longer than their lower-scoring peers.
Post-traumatic growth facilitators
People who are more wealthy, educated, and younger tend to experience higher levels of growth.
This could be because higher SES people tend to be more educated and have fewer financial worries after trauma.
Studies suggest that people who experience more positive emotions will be better equipped to deal with adversity and experience PTG.
Personality may play a factor in this facilitator.
Time and type
PTG researchers are currently trying to understand whether time and the objective severity of a trauma matter in the attainment and valence of growth.
For example, stage 3 cancer is worse than stage 1; however, depending on the individual, stage 1 may be enough to shatter their previous beliefs and send them into a pit of despair.
Additionally, those who are more resilient may not experience higher levels of growth due to their current levels of resilience. Those who can report immediate benefits have lower stress levels several months or years later.
It appears that the reaction and attainment of growth are quite individual.
Coping styles
PTG is not coping, but there are links between coping styles and PTG.
People who use approach-focused coping (active and problem-focused coping) can engage in positive reappraisal, acceptance, seeking social support, and contemplating the reason for the tragedy.
Emotional approach coping is highly beneficial as a greater emotional expression in the immediate aftermath has been linked to PTG.
Avoidance coping can be beneficial depending on the individual, the trauma, and the length of use.
Escape, avoidance, and healthy distraction can be necessary when dealing with trauma, as long as they are not ongoing and are not the only form of coping.
Dynamic coping is ideal for the experience of PTG to exist.
How do we measure it?
The majority of PTG research is measured through quantitative assessment, such as the Stress-Related Growth Scale (SRGS), Post-traumatic Growth Inventory (PTGI), Benefit Finding Scale (BFS), and Changes in Outlook Questionnaire (Joseph et al.,
1993).
These tools tend to ask questions surrounding cognitive shifts in thinking since and related to the trauma.
For example, the PTGI (Tedeschi and Calhoun, 1996) asks individuals to think about the trauma they experienced and respond to the following questions on a Likert scale from 0 (I did not change as a result of the event) to 5 (I changed to a very great degree as a result of the event).
1 My priorities about what is important in life 0 1 2 3 4 5
2 An appreciation for the value of my own life 0 1 2 3 4 5
3 I developed new interests 0 1 2 3 4 5
4 A feeling of self-reliance 0 1 2 3 4 5
5 A better understanding of spiritual matters 0 1 2 3 4 5
Quantitative measurement tools have high internal consistency and reliability. Still, qualitative research strategies allow participants to speak freely about the phenomenon in their own words.
Data is accessed via semi-structured interviews, written responses, focus groups, or diaries.
How does PTG happen?
The transformational model (Tedeschi and Calhoun, 2006) is a leading model of post-traumatic growth (PTG).
Post-traumatic growth is the process of rebuilding around the traumatic experience and acknowledging the trauma in a non-anxious way.
Shattered assumptions theory assumes that we all have an inner world in which we harbor fundamental assumptions of a sense of safety and security.
Organismic valuing theory of growth through adversity (Joseph and Linley, 2008) is a person-centered approach that assumes a person must overcome obstacles in their social environment and not necessarily their pre- or post-trauma personality to obtain PTG. Assimilation is when individuals keep their old worldview and initiate self-blame, while accommodation modifies pre-existing schemas to accommodate new information.
This theory goes beyond discussing outcomes and clarifies the underlying cognitive mechanisms.
The transformational model (Tedeschi and Calhoun, 1995) is the most complete and widely used growth model.
It posits that PTG results from excessive rumination (or cognitive processing) following a seismic event.
After the seismic event, the person is presented with challenges (for example, management of emotional distress). They must then engage in managing excessive rumination in three stages: automatic and intrusive thoughts, deliberate rumination, self-disclosure, and disengaging from previous goals.
Once these processes have been completed, the person can achieve PTG in addition to wisdom or ‘preparedness.’
This model acknowledges that distress can co-exist alongside PTG.
Wisdom
The VIA strengths approach defines wisdom as the ability to take stock of life in large terms, in ways that make sense to oneself and others.
It is more than the accumulation of information; it is the coordination of this information and its deliberate use to improve wellbeing.
There are many approaches to wisdom within the psychology discipline, such as Erik Erickson’s concept of wisdom as the final stage of personality development.
Robert Sternberg’s Balance Theory of Wisdom posits that wisdom comes from solving problems while also taking other people into account, using multiple response strategies, and aiming for the result to serve the common good of all.
According to researchers, wisdom has little to do with age, with levels of wisdom leveling into young adulthood.
It is experience and the amassed encounters with life complexities that create wisdom.
Aging well
Studies have found that higher physical, mental, or social activity levels reduce the risk of cognitive impairment or dementia five or more years later.
Vaillant and his colleagues discovered six factors that do not predict healthy aging: ancestral longevity, cholesterol level at 50, parental social class, warm childhood environment, stable childhood temperament, and stress.
Factors that did predict healthy aging included not being a heavy smoker or stopping smoking young, mature adaptive defenses, absence of alcohol abuse, healthy weight, stable marriage, exercise, and years of education.
The good news is that the list of predictive healthy aging factors includes many aspects under our control.
Older adults tend to experience fewer negative emotions but a similar number of positive emotions and develop greater emotional complexity.
Studies show that with age comes more contentment and the formation of deeper and closer bonds with people, resulting in more satisfaction from relationships.
To engage in successful aging, Lupien and Wan (2004) offer several tips: (1) engage with life and maintain activities that are personally meaningful to you; (2) create environments where you can feel in control and able to make choices; (3) maintain a positive attitude; and (4) always believe that you can keep learning and remember.
Positive attitudes to aging reflect the new reality and reinforce health and capability.
Encouraging positive attitudes is urgent, as is communicating the benefits of age and the ways of improving functioning through exercise and activity.
This can all contribute to creating a positive aging culture.
Stereotypes
Becca Levy and colleagues at Yale University conducted experiments comparing the effects of positive and negative age stereotypes on memory, numerical ability, self-confidence, and cardiovascular responses to stress.
Results showed that positive stereotypes positively affected performance and older adults’ attitudes, while negative stereotypes impaired capability, confidence, and recovery from stress.
Positive stereotypes improved memory, numerical ability, confidence, and the will to live.
Levy (1996) concluded that positive stereotypes minimize the adverse physiological effects of stress in older adults while having no effect on the performance or attitudes of young adults.