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date: 01 December 2020

Posttraumatic Growthfree

  • Selena T. RodgersSelena T. RodgersCity University of New York, York College

Summary

Trauma literature has seen a paradigm shift from pathology to embracing positive trajectories. Posttraumatic growth (PTG), defined as a positive psychological change resulting from a struggle with traumatic or life-changing events, may occur in a variety of populations and events. This entry, therefore, aims to increase our understanding of PTG. The entry begins with the conceptualization of PTG, followed by a discussion of protective factor associations, measures, and psychometric priorities. Nuanced attention is given to global translations and cultural aspects. The entry then presents debates about the challenges, controversy, and biases, as well as an overview of the empirical literature. The entry concludes with PTG contributions for social-work practice and pedagogy, together with recommendations for future research.

What Is Posttraumatic Growth?

Pioneers in the field, Tedeschi and Calhoun (1995, 1996) initially coined the term posttraumatic growth (PTG) to convey a “positive psychological change experienced as a result of the struggle with highly challenging circumstances” (Tedeschi & Calhoun, 2004, p. 1). Conceptually, PTG was introduced as three aspects of perceived changes: (a) in self, (b) in sense of relationships with others, and (c) in philosophy of life (Tedeschi & Calhoun, 1995). Based on empirical evidence, PTG has undergone several conceptual transformations. The Posttraumatic Growth Inventory (PTGI) was developed into five domains of growth to measure renewed appreciation of life, new possibilities, enhanced personal strength, improved relationships with others, and spiritual change (Taku, Calhoun, Cann, & Tedeschi, 2008; Tedeschi & Calhoun, 1996). The latest model (Tedeschi & McNally, 2011) of PTG extends the work of Calhoun and Tedeschi (1998; 2006a, 2006b) and Tedeschi and Calhoun (2004) and endorses other variables that increase the possibility of psychological growth in the aftermath of trauma (Calhoun, Cann, & Tedeschi, 2010).

Tedeschi and McNally (2011, p. 19) summarized the broadened model of PTG as: (a) cognitive processing, engagement, or rumination; (b) disclosure of concerns surrounding traumatic events; (c) the reactions of others to self-disclosures; (d) the sociocultural context in which traumas occur and attempts to process, disclose, and resolve trauma; (e) the personal dispositions of the survivor and the degree to which they are resilient; and (f) the degree to which events either permit or suppress the aforementioned processes. The model also addresses how PTG may relate to wisdom, life satisfaction, and a sense of purpose in life.

Paradox: “Posttraumatic Stress Disorder—Posttraumatic Growth”

Exposure to a traumatic incident may predispose one to develop posttraumatic stress disorder (PTSD). Negative symptoms associated with PTSD have been described as anxiety, fatigue, depression, withdrawal, or lowered social aspiration, whereas positive changes may include closer relationships with family and friends or a greater appreciation of life (Tedeschi & Calhoun, 1995, 2004). The development of characteristic symptoms following exposure to an extreme traumatic event may also include symptoms of avoidance and/or increased arousal from trauma (American Psychiatric Association, 2000).

This section describes the continuum of detrimental and growth outcomes one may talk about following a variety of trauma experiences. Schuettler and Boals (2011) posit that individual reactions to trauma vary greatly. Although some individuals appear unaffected by events, others report a range of negative and/or positive trauma consequences—a paradoxical effect (Calhoun & Tedeschi, 2006a, 2008; Helgeson, Reynolds, & Tomich, 2006; Linley & Joseph, 2006). For some adults with child sexual abuse (CSA) histories the trauma can shatter the assumptive worldview without the possibility of rebuilding or withstanding future shocks (Finkelhor, 1994; Janoff-Bulman, 1992). However, there may also be an “upside” to trauma that may include enhanced personal strength and spiritual change within the model of PTG.

PTSD and PTG have been empirically linked (Lev-Wiesel, Amir, & Besser, 2005; Schuettler & Boals, 2011; Shakespeare-Finch & Copping, 2006; Shakespeare-Finch & Dassel, 2009). Mixed results have been reported concerning this paradox in which PTSD was reported to vary based on the type of traumatic event. In instances of nonsexual assault, women tend to report greater severity of PTSD symptoms (meeting criteria for PTSD). However, no significant gender differences were reported in CSA or adult sexual assault events (see Vishnevsky, Cann, Calhoun, Tedeschi, & Demakis, 2010). There is, however, a divergence in the scholarly literature regarding an association between PTSD and PTG. For example, one study (Lev-Wiesel et al., 2005) found a positive correlation between PTSD and PTG among female survivors of childhood sexual abuse in a predominately Israeli-born sample (n = 93). Further, the relation between PTSD and PTG was mediated by the identity of the perpetrator. That is, when the perpetrator was a family member, participants reported significantly high levels of PTSD, which in turn affected their levels of PTG (Lev-Wiesel et al.). Another study (McCaslin et al., 2009) indicated a curvilinear relationship between peritraumatic dissociation and PTG and between posttraumatic stress symptoms and PTG among Sri Lankan university students who had experienced a traumatic life event (for example, bombings, murder or purposeful killings, domestic violence, sexual and physical abuse, political-related war, arrest, or jail). McCaslin et al. suggested that instances of an optimal level of instantaneous and succeeding distress may promote the development of PTG, whereas low levels of distress may be lacking to arouse growth and an overwhelming amount of distress—during and following the trauma event—may impede the development of growth subsequent to occurrences. However, not all scholars agree that there is a link between PTSD and PTG. No statistically significant relationship was found between PTSD and PTG in an Australian sample of adult survivors of childhood sexual abuse (Shakespeare-Finch & Dassel). Greater understanding is warranted to comprehend the paradoxical effect between PTSD and PTG (Hagenaars & Minnen, 2010). Domains of PTG seem to correspond with Peterson, Park, Pole, D’Andrea, and Seligman’s (2008) characters of strength (for example, improved relationships with others [kindness, love] or openness to new possibilities [curiosity, creativity, love of learning]). Therefore, it is critical to examine the relation between PTG and prominent protective factors (such as rumination, spirituality, and social support).

The Role of Rumination in PTG

It appears that highly stressful events may shatter and rebuild one’s assumptive worldview, setting in motion the process of rumination for achieving the ultimate outcome of PTG (Cobb, Tedeschi, Calhoun, & Cann, 2006; Janoff-Bulman, 1992; Tedeschi & Calhoun, 2004). Moreover, Moberly and Watkins (2008) suggest that ruminative thinking can have negative consequences (intrusive rumination has been linked with depressive symptoms and anxiety) or can serve a more constructive function, such as helping one to recover and perhaps even grow posttrauma. Cann et al. (2009) posit that intrusive rumination tends to occur immediately after a trauma, leading to the development of PTSD, whereas deliberate rumination is more likely to occur later, leading to the development of PTG.

Descriptions of rumination (Calhoun & Tedeschi, 1998) have posited it as the process of repetitive thoughts between the stressor and related issues (that is, instructive). Other conceptualizations of rumination have made a distinction between brooding and reflective. Later accounts indicate a more deliberate, reflective process for rebuilding one’s general way of understanding the world (Calhoun & Tedeschi, 2006a, 2006b). The characteristics of the rumination process are a necessary element for coping with traumatic events and outcomes of PTG (Calhoun & Tedeschi, 2006a, 2006b; Phelps, Williams, Raichle, Turner, & Ehde, 2008).

Calhoun and Tedeschi (1998, 2006a, 2006b) also refer to rumination as the extent to which one finds meaning in an event, thus noticing changes in self. Results from two studies, for example, found a positive association between PTG and deliberate rumination (Cann, Lawrence, Tedeschi, & Solomon, 2010; Stockton, Hunt, & Joseph, 2011) and a negative relation to recent intrusive rumination (Cann et al., 2010). Other studies have shown negative (Roelofs, Muris, Huibers, Peeters, & Arntz, 2006; Shirotsuki, Sasagawa, & Nomura, 2007) and positive rumination in culturally diverse student populations (Noguchi & Fujiu, 2007; Taku et al., 2008).

PTG and Spirituality

Calhoun and Tedeschi’s (2006a) model of PTG incorporates renewed spirituality as part of its spiritual change domain. The empirical literature indicates that spiritual domains significantly impact the growth process in the aftermath of stressful life events (Bray, 2010). Sheridan (2004), in her article Predicting the use of spiritually derived interventions in social work practice: A survey of practitioners, defines spirituality as “the search for meaning, purpose, and connection with self, others, the universe, and ultimate reality, however one understands it, which may or may not be expressed through religious forms or institutions” (p. 10). She distinguishes spirituality and religion by stating that religion is “an organized structured set of beliefs and practices shared by a community related to spirituality” (p. 10). Calhoun and Tedeschi (1999) underscore that “the domain of spirituality is one in which individuals can experience significant posttraumatic growth” (p. 117).

Earlier research demonstrates mixed results between spiritual activities and PTG (Schultz, Tallman, & Altmaier, 2010; Vis & Boynton, 2008). PTG, spirituality, and religion have yielded mixed results (Kissil, Niño, Jacobs, Davey, & Tubbs, 2010; Schultz et al., 2010). Some findings suggest a decline in religion or spirituality in some survivors of abuse (Pargament, Desai, & McConnell, 2006), whereas other findings indicate religious coping is positively associated with PTG (Linley & Joseph, 2004). In another instance, PTG was important in mediating religion and spirituality (Schultz et al., 2010). Within the spiritual change domain, an individual’s intentional engagement with the stressor or traumatic event might include finding meaning, achieving interconnectedness with self or others, and actively seeking social support (Stanton, Bower, & Low, 2006). It is within this construct, then, that spirituality may play a key role in one’s search for meaning (Linely & Joseph, 2011) and perception of social support and outcomes of positive psychological change resulting from a struggle with traumatic or life-changing events (Rodgers, 2011a, 2013b).

Perceived Social Support and PTG

Social support is considered an important environmental resource for understanding PTG (Schaefer & Moos, 1998; Tedeschi & Calhoun, 2004). Social support has been defined as the emotional assistance, advice, guidance, and material aid and services people obtain from their relationships (Sarason, Levine, Basham, & Sarason, 1983; Thornton & Perez, 2006). Findings documenting this relationship are mixed. For example, perceived social support or satisfaction and PTG were related in some cancer survival populations (Senol-Durak & Ayvasik, 2010), bereaved HIV/AIDS caregivers (Cadell, Regehr, & Hemsworth, 2003), Gulf War I veterans (Maguen, Vogt, King, King, & Litz, 2006), refugee-like situations (Rodgers, 2008, 2012a), sexual assault survivors (Frazier, Tashiro, Berman, Steger, & Long, 2004), spinal cord injury sufferers (McMillen & Cook, 2003), Holocaust survivors (Lev-Wiesel & Amir, 2003), and women with multiple sclerosis (Mohr et al., 1999). However, this relationship was not pronounced in other cancer patients (for example, Cordova, Cunningham, Carlson, & Andrykowski, 2001; Sears, Stanton, & Danoff-Burg, 2003; Weiss, 2004b; Widows, Jacobsen, Booth-Jones, & Fields, 2005). Still others (Park, Cohen, & Murch, 1996; Tedeschi & Calhoun, 2004) found that people who reported satisfaction with social support and perceived greater availability of social support revealed significantly higher levels of growth than those with less or absent resources.

Still others (Park, Cohen, & Murch, 1996; Tedeschi & Calhoun, 2004) found that people who reported satisfaction with social support and perceived greater availability of social support revealed significantly higher levels of growth than those with less or absent resources. Rodgers (2008) also found a positive correlation between PTG and social support satisfaction, but an inverse relationship between the number of perceived social supports and PTG in Latina immigrants in refugee-like situations. Rodgers’ (2008) asserts that the latter finding is unique and important to interpret within the Latino Worldview (La Raza) conceptual framework (Añez, Paris, Bedregal, Davidson, & Grilo, 2005). Moreover, women in refugee-like situations likely emerged from the struggle associated with political repression and an absence of supportive resources through their Latino values that include Aguantarse (the ability to withstand stressful situations during difficult times) and the use of Latino spirituality or fatalismo, fatalism, fate—a belief in divine intervention and/or predetermination (Añez et al., 2005; Rodgers, 2008, 2012a).

Measuring PTG

PTG has been assessed using a variety of qualitative questions and quantitative measures (for example, the Stress Related Growth Scale or the PTGI). This entry highlights the latter. According to Tedeschi and Calhoun (2004), “The Posttraumatic Growth Inventory . . . was developed to allow qualification of the experiences of growth” (p. 5). The PTGI (Tedeschi & Calhoun, 1996) is widely used to capture positive changes following crisis, stressors, or trauma. The PTGI has well-established validity and reliability and its ability to capture the multidimensional quality of personal growth has been documented (Tedeschi & Calhoun, 1996). The original PTGI 21-item English version includes five factors: appreciation of life (5 items), relating to others (7 items), new possibilities (4 items), personal strength (3 items), and spiritual change (2 items) (Tedeschi & Calhoun, 1996). The original PTGI demonstrates good internal consistency, with Cronbach’s alpha = .90 (Tedeschi & Calhoun, 1996).

The Posttraumatic Growth Inventory Short Form (PTGI-SF) also assesses positive changes experienced in the aftermath of traumatic or life-changing events, reflecting five domains: appreciation of life, relating to others, new possibilities, personal strength, and spiritual change (Tedeschi & Calhoun, 1996). Respondents answer the 10-item measure on a 6-point Likert scale (0 = no change; 5 = very great degree). The PTGI-SF has an internal reliability only slightly lower than that of the full-form PTGI, and the reliability of the total score was generally in the range of .90 across a variety of samples (Cann et al., 2009).

The Format Posttraumatic Growth Inventory (PTGI-42; Baker, Kelly, Calhoun, Cann, & Tedeschi, 2008) is a revision of the PTGI (Tedeschi & Calhoun, 1996). The scale includes the 21 items from the original PTGI and 21 matched but negatively worded items developed by Baker et al. (2008) to measure posttraumatic depreciation. On a Likert scale, the participants are asked to indicate the degree to which they experienced the change described by each item using a 6-point scale ranging from 0 (“I did not experience this change as a result of my crisis”) to 5 (“I experienced this change to a very great degree as a result of my crisis”). Participants are encouraged to consider both types of change, growth and depreciation, at the same time. This also should facilitate the scorer’s mapping of the two changes onto the same scale. The 21 positive items and the 21 negative items are separately summed to create PTG and posttraumatic depreciation composite scores (possible range of 0 to 105). In the development of the scale, the internal reliabilities for both composite scores were at least .89 across two separate samples.

PTG experiences in children and adolescents have also been examined using open-ended questions and a mixture of quantitative and qualitative measures (for example, Ickovics, Meade, & Kershaw, 2006; Kimhi, Eshel, Zysberg, & Hantamn, 2010; Kissil et al., 2010).

An adaptation of the Posttraumatic Growth Inventory for Children (PTGI-C) (Cryder, Kilmer, Tedeschi, & Calhoun, 2006) was revised (PTGI-C-R), shortened, and simplified to facilitate efficient assessment of PTG in clinical and research settings (Kilmer et al., 2009). According to Kilmer (2006), the PTGI-C-R includes 2 open-ended items and 10 items assessing five PTG domains (new possibilities, relating to others, personal strength, appreciation of life, and spiritual change) on a 4-point scale. The PTGI-C-R provides a brief means of assessing PTG in children; its simplified format, content, and language addresses the developmental challenges inherent in such work (Kilmer, 2006).

PTGI: Global Translations

The PTG instrument has been widely used around the globe (Shakespeare-Finch & Copping, 2006; Splevins, Cohen, Bowley, & Joseph, 2010) and translated to Arabic (Salo, Qouta, & Punamäki, 2005), Bosnian (Powell, Rosner, Butollo, Tedeschi, & Calhoun, 2003), Chinese (Ho, Chan, & Ho, 2004), Dutch (Jaarsma, Pool, Sanderman, & Ranchor, 2006), Greek (Mystakidou et al., 2007), German (Maercker & Langner, 2001), Hebrew (Laufer & Solomon, 2006; Solomon & Laufer, 2005), Japanese (Taku et al., 2007), Norwegian (Holgersen, Boe, & Holen, 2010), Spanish (Weiss & Berger, 2006), and Turkish (Kilic, 2005). Cross-cultural validation of the PTGI has been conducted in a growing number of studies (Kroo & Nagy, 2011). Some translations have yielded only a few of the same conceptual domains as in the original English PTGI. Whereas the Dutch version of the PTGI validated reported a five-factor structure among cancer survivors (Jaarsma et al., 2006), others have reported a four-factor (Ho et al., 2004; Maercker & Langner; Taku et al., 2008) or three-factor (Dirik & Karanci, 2008; Powell et al., 2003; Salo et al., 2005; Weiss & Berger) structure. Peltzer (2000) evidenced the five-factor solution in a South African study. With the exception of an Iranian sample (76.1%, Rahmani et al., 2012), mean scores were lower in non-U.S. samples: German (64.3%, Maercker & Langner), Chinese (59.3%, Ho et al.); Dutch (45%, Jaarsma, 2006), and Arabic (45.9%, Salo, 2005). According to Tedeschi and Calhoun’s (1996) U.S. sample, total PTGI mean scores were 75.18 for females and 67.77 for males.

Diverse worldviews may have implications for the growth process (Calhoun et al., 2010; Splevins et al., 2010). Although several studies have changed the wording of the PTGI to enhance its meaningfulness, (for example, Powell et al., 2003; Taku et al., 2008), Shakespeare-Finch and Copping (2006) contend that these differences in dimensions or items of PTG seem to vary depending on cultural characteristics. For example, Thombre, Sherman, & Simonton (2010) reported that reappraisal of worldviews was the strongest concurrent predictor of PTG. One explanation offered by Shakespeare-Finch and Copping suggests that the PTGI does not entirely capture growth in non-U.S. trauma survivors. Using the domain of spiritual change (Tedeschi & Calhoun, 1996) as an example, some researchers have documented that certain European populations are less likely to answer spirituality items or view religiosity as a form of strength (Harms & Talbot, 2007; Znoj, 2006). At the other end of the spectrum, religious coping has been reported to be positively associated with PTG (Linley & Joseph, 2004) in women of color (Stanton et al., 2006). Consequently, PTG remains controversial because of such measurement challenges (Park & Lechner, 2006).

Validating PTG: Challenges, Controversy, Biases

PTG has been identified as the most widely used term for describing adaptations to traumatic stressors (Gibbons, Murphy, & Joseph, 2011), Yet, challenges in validating the construct of PTG include opposition from skeptics who argue that the self-reports obtained through interviews or questionnaires are invalid (for example, Frazier & Kaler, 2006). Attempts to distinguish PTG from closely related constructs represent another challenge (Joseph & Linley, 2008).

Challenges in validating the construct of PTG include attempts to distinguish PTG from closely related constructs including benefit finding (Helgeson et al., 2006; Nolen-Hoeksema & Davis, 2004; Sears et al., 2003; Linley & Joseph, 2006), hardiness (Kobasa, Maddi, & Kahn, 1982), stress-related growth (Park et al., 1996), thriving (O’Leary & Ickovics, 1995), and resilience (Bonanno, 2004). Upon closer inspection, the link between struggling with an event and positive outcome expectancies has been conceptualized as dispositional optimism, a construct originating from self-regulation theory, a trait reflecting a positive expectancy of good outcomes by the individual confronting major problems or stress (Scheier & Carver, 1985); hardiness (the perceptions of one’s ability to handle problems or difficulties and the required skills to successfully resolve situations created by stressful events) (Kobasa et al., 1982); thriving, grounded in constructivist self-development theory (the ability, in some instances, to go beyond the original level of psychological functioning, to grow vigorously, “bounce forward,” even flourish following a stressful encounter; O’Leary & Ickovics); resilience (the ability to go through difficulties such as a violent life-threatening situation and regain satisfactory quality, healthy levels of psychological and physical functioning and generate experiences and positive emotions) (Bonanno, 2004, 2005); benefit finding (the ability to successfully adapt in the face of adaptation) (Janoff-Bulman & McPharson-Frantz, 1997); and PTG (the positive psychological change as a result of the struggle with highly, stressful events) (Calhoun & Tedeschi, 1999; Tedeschi & Calhoun, 2004).

The validity of difference between PTG and resilience has remained a controversial discussion in the literature (Bonanno, 2004; Westphal & Bonanno, 2007). Tedeschi and Calhoun (1996, 2004) assert that PTG is distinct from resilience in that resilient individuals are the least likely to experience transformation caused by an emphasis on single-trait-like responses, whereas PTG is transformative because of its multiple-component model (that is, new possibilities, relating to others, personal strength, appreciation of life, spiritual change). Tedeschi and Kilmer (2005) have posited that PTG captures the essentials of transformative positive changes that (a) occur most distinctively in the aftermath of an extreme stressor rather than during lower level stress, (b) appear to go beyond the original level of physiological functioning, (c) are experienced as an outcome rather than a coping mechanism, and (d) require a shattering of basic assumptions about one’s life that extreme stressors cause but lower levels of stress do not. Calhoun and Tedeschi (1999) argue that whereas PTG is transformative, resilience is not. PTG is most pronounced among those who report extreme stressor experiences (Tedeschi & Calhoun, 1996).

Conversely, Lepore and Revenson (2006) contend that both resilience—which is rooted in the abnormality of behaviors and risk factors of poverty in children (Garmezy, 1993)—and PTG are forms of reconfiguration. However, PTG is different from resilience, in that the concept is usually considered an ability to adjust back to baseline functioning after experiencing adversity (Kissil et al., 2010). This unresolved theoretical debate reinforces the need to further examine when growth outcomes are most likely to occur.

Smith and Cook (2004) posed the question of whether PTG was positively biased. Several researchers (Holgersen et al., 2010; Maercker & Zoellner, 2004; Westphal & Bonanno, 2007) posit that perceptions and measures of PTG are positively biased and illusory because measures have not allowed samples to report possible negative posttraumatic changes that may also result from negative occurrences. As a response, Baker created the PTGI-42 (Baker, Kelly, Calhoun, Cann, & Tedeschi, 2008), which includes the 21 items from the original PTGI and 21 matched but negatively worded items developed by Baker et al. (2008) to measure posttraumatic depreciation.

An Empirical Overview

Multiple approaches were employed to identify relevant studies that examine Calhoun and Tedeschi’s (1998) and Tedeschi and Calhoun’s (2004) model of PTG. Initially, the author conducted an extensive search of computerized databases—SociIndex, PsychINFO, Medline, and Academic Search Premier. Follow-up searches were conducted using reference lists from articles and book chapters. PTG has been evidenced in a variety of populations following a wide range of traumatic circumstances (Linley & Joseph, 2004; Taku et al., 2008). Examples are listed here and in the Further Reading section.

Bereavement

Cadell et al. (2003)

Engelkemeyer and Marwit (2008)

Bombings and terrorism

Butler et al. (2005)

Hall et al. (2010)

Val and Linley (2006)

Brain injury

Powell, Gilson, and Collin (2012)

Cancer survivors

Arpawong, Richeimer, Weinstein, Elghamrawy, and Milam (2013)

Cordova et al. (2001)

Weiss (2002, 2004a, 2004b)

Childhood sexual abuse

Shakespeare-Finch and Dassel (2009)

Lev-Wiesel et al. (2005)

Rodgers (2011a)

Ex-prisoners of war, refugees, and refugee-like situations

Dekel (2007)

Hussain and Bhushan (2011)

Kroo and Nagy (2011)

Powell et al. (2003)

Salo et al. (2005)

Rodgers (2008, 2012a)

HIV/AIDS caregivers, HIV-infected and HIV-related stigma

Cadell et al. (2003)

Milam (2006)

Nightingale, Sher, and Hansen (2010)

Intimate partner violence

Cobb et al. (2006)

Heart disease

Bluvstein, Moravchick, Sheps, Schreiber, and Bloch (2013)

Historical trauma

Rodgers (2013a)

Holocaust experiences

Lev-Wiesel and Amir (2003)

Leukemia

Danhauer et al. (2013)

Loss of a child

Polatinsky and Esprey (2000)

Parents of hospitalized infants

Barr (2011)

Police officers and duty-related shootings

Chopko (2013)

Rheumatoid arthritis

Dirik and Karanci (2008)

Rape and sexual assault

Frazier et al. (2004)

Bush, Skopp, McCann, and Luxton (2011)

Kimhi et al. (2010)

Maguen et al. (2006)

Mothers of children with acquired disabilities

Konard (2006)

Motor vehicle and traffic accidents

Harms and Talbot (2007)

Zöellner, Rabe, Karl, and Maercker (2008)

Multiple sclerosis

Mohr et al. (1999)

Natural disasters—hurricanes, earthquakes, and tsunamis

Bhushan (2012)

Cryder et al. (2006)

Holgersen et al. (2010)

Kilmer and Gil-Rivas (2008)

Lowe, Manove, and Rhodes (2013)

Rhodes and Tran (2013)

Physical assault

Grubaugh and Resick (2007)

Kleim and Ehlers (2009)

Spinal cord injury

McMillen and Cook (2003)

Stroke

Gangstad, Norman, and Barton (2009)

Substance use in homeless women

Stump and Smith (2008)

Vicarious trauma

Rodgers (2013b)

Violence

Kleim and Ehlers (2009)

Kunst (2010)

Proffitt, Cann, Calhoun, and Tedeschi (2007)

A recent meta-analysis was conducted by Vishnevsky et al. (2010) and Prati and Pietrantoni (2009) to examine the direction and magnitude of gender differences in self-reported PTG and the role of optimism, social support, and coping strategies in contributing to PTG, respectively. Concerning gender differences, Vishnevsky and colleagues reported small to moderate gender differences, with women reporting more PTG than men. However, Kimhi et al. (2010) found that females reported lower levels of PTG compared with their male counterparts. Additionally, Prati and Pietrantoni showed that although gender was a significant moderator of religious coping, effect size did not differ based on gender. Other results from Prati and Pietrantoni’s meta-analysis revealed that certain variables yielded significant effect sizes (religious coping and positive reappraisal coping, acceptance coping, social support, seeking social support coping, spirituality, and optimism).

Prati and Pietrantoni (2009) also found age to be a significant moderator of religious coping. Other studies of demographic characteristics including age yielded inconsistent findings. Some studies (for example, Carver & Antoni, 2004; Kimhi et al., 2010; Powell et al., 2003; Widows et al., 2005) found that younger age was associated with greater PTG in people with cancer and from war-afflicted communities, whereas others reported nonsignificant results in cancer survivors (see Calhoun & Tedeschi, 2006b).

Research documenting PTG in culturally and ethnically diverse populations is also evolving (Calhoun et al., 2010; Splevins et al., 2010). Ethnicity, in particular person of color status, has been associated with greater PTG (Stanton et al., 2006). Specifically, African American and Latina women with breast cancer reported greater PTG than White women (Bellizzi et al., 2010; Tomich & Helgeson, 2004; Urcuyo, Boyers, Carver, & Antoni, 2005). Additional studies are needed that make clearer ethnic distinctions among study samples and cross-cultural variation in PTG experiences (Helgeson et al., 2006; Kissil et al., 2010; Milam, 2006; Rhodes & Tran, 2013).

PTG Contributions to Social-Work Practice and Pedagogy

There is little debate that social work has focused attention on empowerment and that strength-based perspectives have a strong likeness to PTG’s positive psychological perspectives (DuBois & Miley, 2011). Notwithstanding the profession’s set of core values including service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence (Preamble, Code of Ethics, National Association of Social Workers, 1996), another central purpose of social work is to engage various populations who experience trauma. In light of the growing challenges faced by social-work students, opportunities exist for a greater contribution of cross-cultural understanding of PTG within social-work practice and pedagogy (for example, National Association of Social Workers, 2008; Rhodes & Tran, 2013; Roberts, Barnett, & Kelley, 2012; Rodgers, 2011b, 2014).

Researchers (Gibbons et al., 2011; Rodgers, 2012b, 2013b; Tosone et al., 2003) who have used various PTGI measures to examine PTG in social workers and social-work students have reported moderate levels of PTG. Breckenridge and James (2010), Knight (2010), and Rodgers (2012b, 2013b) affirm that social-work students and supervisors alike face unprecedented challenges to respond effectively to a variety of trauma-related experiences, including globalization, civil wars and political strife, human trafficking, incest, forced migration, HIV/AIDS, violence, and technological and natural disasters. Given the earlier evidence that PTG occurs in a variety of populations encountered by social workers at micro, messo, and macro levels, there is an impetus for social-work educators to prepare students to practice and pedagogy PTG content is immersed throughout the social-work curriculum—research, diversity, policy, human behavior, and technology (Council on Social Work Education [CSWE], 2008).

In particular, greater emphasis should be placed on field placement, also referred to as the “signature pedagogy” of social-work education, because the CSWE has deemed it the central form of instruction and learning in which a profession socializes its students to perform the role of practitioner (Council on Social Work Education Commission on Accreditation, 2012). The signature pedagogy is an essential, tangible benefit of professional education and is the central mechanism through which students learn to integrate and apply theory and practice (CSWE, 2008; Knight, 2000; Rodgers, 2014). Research findings (Rodgers, 2013b) underscore the need for curricular modifications to expose students and supervisors (Rodgers & Cudjoe, 2012) to specific knowledge of traumatic events and coping responses. Based on an extensive review, future studies should continue to explore aspects of social-work interventions using Tedeschi and McNally’s (2011) latest model of PTG, as well as an examination of cultural aspects of PTG (Calhoun et al., 2010; Splevins et al., 2010).

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  • Thombre, A., Sherman, A. C., & Simonton, S. (2010). Posttraumatic growth among cancer patients in India. Journal of Behavior Medicine, 33, 15–23. doi:10.1007/s10865-009-9229-0
  • Thornton, A. A., & Perez, M. A. (2006). Posttraumatic growth in prostate cancer survivors and their partners. Psycho-Oncology, 15, 285–296.
  • Tomich, P. L., & Helgeson, V. S. (2004). Is finding something good in the bad always good? Benefit finding among women with breast cancer. Health Psychology, 23, 16–23. doi:10.1037/0278-6133.23.1.16
  • Tosone, C., Bialkin, L., Campbell, M., Charters, M., Gieri, K., Gross, S., et al. (2003). Shared trauma: Group reflections on the September 11th disaster. Psychoanalytic Social Work, 10, 57–77. doi:10.1300/J032v10n01 06
  • Urcuyo, K. R., Boyers, A. E., Carver, C. S., & Antoni, M. H. (2005). Finding benefit in breast cancer: Relations with personality, coping and concurrent well-being. Psychology and Health, 20, 175–192.
  • Val, E., & Linley, P. (2006). Posttraumatic growth, positive changes, and negative changes in Madrid residents following the March 11, 2004 Madrid train bombings. Journal of Loss and Trauma, 11, 409–424.
  • Vis, J. A., & Boynton, H. M. (2008). Spirituality and transcendent meaning making: Possibilities for enhancing posttraumatic growth. Journal of Religion and Spirituality in Social Work, 27, 69–86.
  • Vishnevsky, T., Cann, A., Calhoun, L. G., Tedeschi, R. G., & Demakis, G. J. (2010). Gender differences in self-reported posttraumatic growth: A metaanalysis. Psychology of Women Quarterly, 34, 110–120. doi:10.1111/j.1471-6402.2009.01546.x
  • Weiss, T. (2002). Posttraumatic growth in women with breast cancer and their husbands: An intersubjective validation study. Journal of Psychosocial Oncology, 20, 65–80. doi:10.1300/J077v20n02_04
  • Weiss, T. (2004a). Correlates of posttraumatic growth in husbands of breast cancer survivors. Psycho-Oncology, 13, 260–268.
  • Weiss, T. (2004b). Correlates of posttraumatic growth in married breast cancer survivors. Journal of Social and Clinical Psychology, 23, 733–746.
  • Weiss, T., & Berger, R. (2006). Reliability and validity of a Spanish version of the Posttraumatic Growth Inventory. Research on Social Work Practice, 16, 191–199. doi:10.1177/1049731505281374
  • Westphal, M., & Bonanno, G. A. (2007). Posttraumatic growth and resilience to trauma: Different sides of the same coin or different coins? Applied Psychology, 56, 417–427. doi:10.1111/j.1464-0597.2007.00298.x
  • Widows, M. R., Jacobsen, P. B., Booth-Jones, M., & Fields, K. K. (2005). Predictors of posttraumatic growth following bone marrow transplantation for cancer. Journal of Health Psychology, 24, 266–273. doi:10.1037/0278-6133.24.3.266
  • Znoj, H. (2006). Bereavement and posttraumatic growth. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research and practice (pp. 176–196). Mahwah, NJ: Erlbaum.
  • Zöellner, T., Rabe, S., Karl, A., & Maercker, A. (2008). Posttraumatic growth in accident survivors: Openness and optimism as predictors of its constructive or illusory sides. Journal of Clinical Psychology, 64, 245–263.

Further Reading

  • Ai, A. L., Tice, T. N., Whitsett, D. D., Ishisaka, T., & Chim, M. (2007). Posttraumatic symptoms and growth of Kosovar war refugees: The influence of hope and cognitive coping. Journal of Positive Psychology, 2, 55–65. doi:10.1002/jts.20623
  • Armstrong, D., & Shakepeare-Finch, J. (2011). Relationship to the bereaved and perceptions of severity of trauma differentiate elements of posttraumatic growth. OMEGA, 63(2), 125–140. doi:10.2190/OM.63.2.b
  • Berger, R., & Weiss, T. (2002). Immigration and posttraumatic growth: A missing link. Journal of Immigrant and Refugee Issues, 1, 21–39.
  • Berger, R., & Weiss, T. (2006). Posttraumatic growth in Latina immigrants. Journal of Immigrants and Refugee Studies, 4, 55–72.
  • Blix, I., Hansen, M. B., Birkeland, M. S., Nissen, A., & Heir, T. (2013). Posttraumatic growth, posttraumatic stress and psychological adjustment in the aftermath of the 2011 Oslo bombing attack. Health and Quality of Life Outcomes, 11, 160–166. doi:10.1186/1477-7525-11-160
  • 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 and Trauma, 16, 13–32, 2011. doi:10.1080/15325024.2010.507658
  • Denney, R. M., Aten, J. D., & Leavell, K. (2011). Posttraumatic spiritual growth: A phenomenological study of cancer survivors. Mental Health, Religion & Culture 14(4), 371–391. doi:10.1080/13674671003758667
  • Devine, K. A., Reed-Knight, B., Loiselle, K. A., Fenton, N., & Blount, R. L. (2010). Posttraumatic growth in young adults who experienced serious childhood illness: A mixed-methods approach. Journal of Clinical Psychology in Medical Settings, 17, 340–348. doi:10.1007/s10880-010-9210-7
  • Fischer, P., & Ai, A. L. (2008). International terrorism and mental health: Recent research and future directions. Journal of Interpersonal Violence, 23, 339–361.
  • Frazier, P., Conlon, A., & Glaser, T. (2001). Positive and negative life changes following sexual assault. Journal of Consulting and Clinical Psychology, 69, 1048–1055.
  • Kaler, M. E., Erbes, C. R., Tedeschi, R. G., Arbisi, P. A., & Polusny, M. A. (2011). Factor structure and concurrent validity of the Posttraumatic Growth Inventory–Short Form among veterans from the Iraq War. Journal of Traumatic Stress, 24(2), 200–207. doi:10.1002/jts.20623
  • Levine, S. Z., Laufer, A., Hamama-Raz, Y., Stein, E., & Solomon, Z. (2009). Examining the relationship between resilience and posttraumatic growth. Journal of Traumatic Stress, 22(4), 282–286. doi:10.1002/jts.20409
  • Linley, P. A., Joseph, S., & Goodfellow, B. (2008). Positive changes in outlook following trauma and their relationship to subsequent posttraumatic stress, depression, and anxiety. Journal of Social and Clinical Psychology, 27, 877–891. doi:10.1521/jscp.2008.27.8.877
  • Love, C., & Sabiston, C. M. (2011). Exploring the links between physical activity and posttraumatic in young adult cancer survivors. Psycho-Oncology, 20, 278–286. doi:10.1002/pon.1733
  • Milam, J. E., Ritt-Oslon, A., & Unger, J. B. (2004). Posttraumatic growth among adolescents. Journal of Adolescent Research, 19(2), 192–204.
  • Morris, B. A., Shakespeare-Finch, J., Rieck, M., & Newbery, J. (2005). Multidimensional nature of posttraumatic growth in an Australian population. Journal of Traumatic Stress, 18, 575–585. doi:10.1002/jts.20067
  • Murphy, P., & Hevey, D. (2013). The relationship between internalised HIV-related stigma and posttraumatic growth. AIDS and Behavior, 17, 1809–1818. doi:10.1007/s10461-013-0482-4
  • Nishi, D., Matsuoka, Y., & Kim, Y. (2010). Posttraumatic growth, posttraumatic stress disorder and resilience of motor vehicle accident survivors. Biosocial Medicine, 4(7), 1–7.
  • Salsman, J., Segerstrom, S., Brechting, E., Carlson, C., & Andrykowski, M. (2009). Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: A 3-month longitudinal examination of cognitive processing. Psycho-Oncology, 18, 30–41.
  • Shakespeare-Finch, J., & Armstrong, D. (2010). Trauma type and post-trauma outcomes: Differences between survivors of motor vehicle accidents, sexual assault and bereavement. Journal of Loss and Trauma, 15(2), 65–82.
  • Shaw, A., Joseph, S., & Linley, P. A. (2005). Religion, spirituality, and posttraumatic growth: A systematic review. Mental Health, Religion, and Culture, 8, 1–11.
  • Solomon, Z., & Dekel, R. (2007). Posttraumatic stress disorder and posttraumatic growth among Israeli ex-POWs. Journal of Traumatic Stress, 20, 303–312.
  • Tedeschi, R., & Calhoun, L. (2008). Beyond the concept of recovery: Growth and the experience of loss. Death Studies, 32, 27–39.
  • Updegraff, K. A., Taylor, S. E., Kemeny, M. E., & Wyatt-Gail, E. (2002). Positive and negative effects of HIV infection in women with low socioeconomic resources. Personality and Social Psychology Bulletin, 28, 282–294.
  • Weiss, T., & Berger, R. (2010). Posttraumatic growth and culturally competent practice: Lessons learned from around the globe. Hoboken, NJ: Wiley.
  • Wolchik, S. A, Cox, S., Tein, J. Y., Sandler, I. N., & Ayers, T. S. (2008–2009). Six-year longitudinal predictors of posttraumatic growth in parentally bereaved adolescents and young adults. OMEGA, 58(2), 107–128. 2008-2009 doi.10.2190/OM.58.2.b
  • Wong, M. L., Cavanaugh, C. E., MacLeamy, J. B., Sojourner-Nelson, A., & Koopman, C. (2009). Posttraumatic growth and adverse long-term effects of parental cancer in children. Families, Systems, & Health, 27(1), 53–63. doi:10.1037/a0014771