Research on traumatic stress in the military tends to focus on negative stress reactions that service members can experience. But many service members affected by trauma also share nuanced stories of loss and struggle that result in unexpected opportunities for personal growth. Posttraumatic growth (PTG), a term coined by Richard Tedeschi and Lawrence Calhoun, is defined as the positive change experienced as a result of the struggle with a major life crisis. The concept of PTG challenges the common assumption that tragedy only results in negative outcomes.
This first blog in a two-part series will provide an overview of PTG and its relevance to military populations. The second blog will discuss therapeutic considerations and strategies for clinicians who work with service members seeking treatment for trauma.
Process and Domains of Post-traumatic Growth
PTG occurs when a primarily adverse event also results in a positive outcome. Traumatic events disrupt an individual’s well-being and often present challenges to his or her basic assumptions and beliefs about the world and his or her place in it. For example, those who have faith in humanity and believe that the world is generally a safe place may question these beliefs after experiencing harm caused by war. Traumatic events often prompt individuals to reconsider basic assumptions and develop new perspectives and beliefs; for some, this arduous coping process can also result in growth. PTG is both an outcome and a process, such that it does not occur purely because of the existence of the traumatic event; rather it is the struggle with the traumatic experience that fosters positive growth.
Research with trauma survivors who have experienced military combat, sexual assault, bereavement, cancer, and HIV found that PTG most commonly occurs within five domains of growth as measured by the Post-traumatic Growth Inventory (PTGI):
Appreciation of life
Greater sense of personal strength
New possibilities and opportunities (e.g., new interests, hobbies, passions)
Spiritual change or development (e.g., new purpose in life, perspective of mortality, deeper sense of spirituality)
PTG in the Military
Service members can be exposed to high levels of stress and potentially traumatic events, whether in operational or combat roles. While it’s recognized that mental health outcomes such as posttraumatic stress disorder (PTSD) and other stressor-related disorders can occur from trauma, it’s also beneficial to educate service members and providers about PTG. It’s important for military personnel to understand that responses to trauma, even maladaptive ones, are normal, but growth can and does occur for some people. In fact, studies have found support for the existence of PTG among military populations, with rates ranging from 59.4 percent among U.S. veterans who reported at least one potentially traumatic event from 2011 to 2013 to 72 percent among veterans exposed to combat exposure from Operations Enduring Freedom and Iraqi Freedom.
Certain factors have been found to be positively correlated with higher levels of PTG:
Severity and intensity of trauma: Service members who have undergone extreme trauma (e.g., improvised explosive device attack or witnessing injury and death) are more likely to report PTG in the form of an enhanced sense of personal strength and a greater overall appreciation for life.
- Optimism and altruism: Positive thinking and open-mindedness can make someone more amenable to accepting growth resulting from a negative experience
Social support: Social support from friends, family and other interpersonal relationships has been found to be an important protective factor in helping to facilitate PTG. It allows service members the opportunity to process the trauma and the back and forth dialogue can help introduce new ways of thinking about the experiences and facilitate important adjustments in a person’s beliefs and assumptions.
Processing trauma takes time and can be a painful process, and service members should be reminded that experiencing stress after a trauma is normal and is not a reflection on their capabilities or character. The possibility of PTG provides some reassurance that despite the adversity and challenges, military personnel can benefit and grow from their experiences.
Stay tuned for the second part of this blog series which will discuss PTG clinical considerations for providers.
Ms. Lauren Restivo is a contracted health systems specialist at the Psychological Health Center of Excellence. She has a master’s degree in criminal justice with a specialty in victimology and substance abuse.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.