Growth After Trauma

Growth After Trauma

Why are some people more resilient than others—and can it be taught?

 

By Lorna Collier
November 2016, Vol 47, No. 10
Print version: page 48

As Kay Wilson struggled to make her way through a Jerusalem forest after being repeatedly stabbed by a Palestinian terrorist, she distracted herself from her agony by playing the song “Somewhere Over the Rainbow” in her mind, composing a new piano arrangement while she fought for breath and forced herself to put one bare foot in front of the other. Wilson, then 46, had been working as a tour guide when, on Dec. 18, 2010, she and a friend were ambushed by terrorists. Wilson witnessed her friend’s murder and was herself viciously stabbed with a machete, ultimately playing dead as her attacker plunged his knife into her chest a final time. She eventually recovered from her severe physical wounds and is healing from her psychological trauma. She now speaks to global audiences about her survival, hoping to “dispel hatred, whether toward Arabs or Jews.” The work “helps me make meaning out of something so senseless,” says Wilson, who is also writing a book about her experiences. After the attack, Wilson had flashbacks and deep survivor’s guilt. But like many people who have survived trauma, she has found positive change as well—a new appreciation for life, a newfound sense of personal strength and a new focus on helping others.

Post-traumatic growth (PTG) is a theory that explains this kind of transformation following trauma. It was developed by psychologists Richard Tedeschi, PhD, and Lawrence Calhoun, PhD, in the mid-1990s, and holds that people who endure psychological struggle following adversity can often see positive growth afterward. “People develop new understandings of themselves, the world they live in, how to relate to other people, the kind of future they might have and a better understanding of how to live life,” says Tedeschi. How can clinicians use PTG theory to help patients? How has new research helped refine understanding of it? Here’s a look at developments in the field.

 

Signs of Post-Traumatic Growth

PTG can be confused with resilience, but the two are different constructs. “PTG is sometimes considered synonymous with resilience because becoming more resilient as a result of struggle with trauma can be an example of PTG—but PTG is different from resilience,” says Kanako Taku, PhD, associate professor of psychology at Oakland University, who has both researched PTG and experienced it as a survivor of
the 1995 Kobe earthquake in Japan. “Resiliency is the personal attribute or ability to bounce back,” says Taku. PTG, on the other hand, refers to what can happen when someone who has difficulty bouncing back experiences a traumatic event that challenges his or her core beliefs, endures psychological struggle (even a mental illness such as post-traumatic stress disorder), and then ultimately finds a sense of personal growth. It’s a process that “takes a lot of time, energy and struggle,” Taku says. “Someone who is already resilient when trauma occurs won’t experience PTG because a resilient person isn’t rocked to the core by an event and doesn’t have to seek a new belief system,” explains Tedeschi. Less resilient people, on the other hand, may go through distress and confusion as they try to understand why this terrible thing happened to them and what it means for their world view.

To evaluate whether and to what extent someone has achieved growth after a trauma, psychologists use a variety of self-report scales. One that was developed by Tedeschi and Calhoun is the Post-Traumatic Growth Inventory (PTGI) (Journal of Traumatic Stress, 1996). It looks for positive responses in five areas:
 Appreciation of life.
 Relationships with others.
 New possibilities in life.
 Personal strength.
 Spiritual change.
“The scale is being revised to add new items that will expand the ‘spiritual change’ domain,” says Tedeschi. This is being “to incorporate more existential themes that should resonate with those who are more secular” as well as reflect cross-cultural differences in perceptions of spirituality.

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Blog was an excerpt from: Collier, L. (2016, November). Growth After Trauma – Why are some people more resilient than others—and can it be taught? The American Psychological Association47(10), 48-50. doi:http://www.apamonitor-digital.org/apamonitor/201611?pg=51#pg51

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Depression In Teens Shouldn’t Be Ignored

Credit for the following post goes to the American Counseling Association’s Counseling Corner Blog. If you are interested in reading more of their content, their website can be found at the bottom of this blog.

“If there’s a teenager in your home, he or she, at various times, is probably moody, ecstatic, angry, happy and just about every other emotional state you can think of.

The fact that your teen can seem like an entirely different person at various times is fairly easy to explain. The teenage years are a pretty difficult time. Teens face all kinds of pressures. Their bodies are changing, their friendships can be volatile, there are demands at school and the uncertainty of college or career decisions.

It’s not an easy time of life and one issue, which can be easy to overlook, is that a teen can face a very real and serious mental health problem — depression.

Teen depression is more than the moodiness that many teens display in everyday situations. Teen depression is described as prolonged, persistent feelings of sadness and is characterized by a loss of interest in most activities.

It’s a problem that not only shuts out the happiness that ought to be part of the teenage years, but can also lead to serious consequences, including suicide. Teen suicide is one of the leading causes of teenage deaths and leads to thousands of hospital visits resulting from suicide attempts.

It’s vital for parents to recognize the signs of clinical depression and to get help for their teenager when needed.

There are a number of signs to look for in your teen, some emotional and others behavioral.  A depressed teen will often feel sad, perhaps even experiencing crying spells for no apparent reason. The teen may be easily annoyed or angry, and may express feelings of  worthlessness or guilt or hopelessness.

The teen’s behavior will also be changed, including losing interest in most activities. Your teen  may seem lacking in energy, or may be overly active. Sleeping too much or insomnia may occur. There may be a loss of appetite, or suddenly overeating.

One sure sign of teen depression is when the teen’s loss of interest and happiness goes on for a period of more than two weeks. This is a time to take action, especially immediate action if a teen starts talking of suicide or makes a suicide attempt.

If your teen is showing signs of depression, talk to your family physician or contact a professional counselor. If you sense the potential of suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255.

 

 

 

 

 

American Counseling Association’s Counseling Corner Blog. (2019). Depression In Teens Shouldn’t Be Ignored. Retrieved July 13, 2019, from https://www.counseling.org/news/aca-blogs/aca-counseling-corner/aca-counseling-corner-blog/2019/07/03/depression-in-teens-shouldn’t-be-ignored.

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Extreme Acceptance

Not everything that happens to us in life is something we signed up for.

There are some things in the past we desperately wish never happened to us.

There are other things in the present we desperately wish we could change. In fact, there are even people we desperately wish we could change.

Extreme Acceptance means accepting something that you emphatically do not like. Extreme Acceptance does not mean that you approve of or agree with the situation—but it does mean that you will acknowledge and embrace the situation anyway. Extreme Acceptance is the exact opposite of denial. Denial is adaptive when we are still in shock and the brain needs to protect us from information that we cannot handle yet. But denial is no longer adaptive when we constantly have blinders on that prevent us from seeing realty how it really is. Long-term, ongoing denial is basically when we lie to ourselves—and then believe our own lie!

Extreme Acceptance, in contrast, means we see reality exactly how it is—no better, and no worse. 

 

Why should we learn to practice Extreme Acceptance? Well, here are a few reasons to consider:

First- Just because you deny reality does not mean that problems just go away. In fact, the opposite is true: The more we make an
ongoing habit of denying reality, the worse our problems get—not better!

Second Another reason to practice Extreme Acceptance is because pain cannot be avoided anyway. Pain is simply a fact of life. We all have pain. A baby’s first emotional response to life is to cry. Why? Because coming into this world is painful…just ask the mother! And even death is sometimes painful. And then there’s plenty of pain in between. So in short, it’s not possible to avoid all that pain, no matter how hard we try.

Third- A third reason to practice Extreme Acceptance is that we must accept reality before we can change it! Accepting reality is indeed painful, since we are becoming more aware of painful things that we would prefer to ignore. But eventually, Extreme Acceptance leads to peace and freedom. Why? Because Extreme Acceptance puts us in a better position to deal with reality (*Linehan, 2015).

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Since Extreme Acceptance can be such a difficult idea to grasp, here are two formulas that help explain this concept better:
Pain + Extreme Acceptance = Healing 

or 

Pain – Extreme Acceptance = Suffering

 Both of these equations include pain.  However, our response to pain is what determines the outcome of this equation. If we demonstrate Extreme Acceptance of the pain, we are now on the path to healing. But when we do not practice Extreme Acceptance, that pain only gets worse! When pain gets worse instead of better, we will experience suffering rather than healing. Something else we can learn from these two formulas is that pain is required, but suffering is optional. I do not mean that everything you have suffered in your life is your fault. However, now that you are learning new skills and new insights in this blog series, the pain in your life does not have to keep piling up or getting worse. By demonstrating Extreme Acceptance, you really can start to turn the tide on your suffering. You can switch from the path that leads to suffering—to the path that leads to healing. Both paths will still have pain. But the pain on the healing path is bearable, while the pain on the suffering path is not. And that’s an important difference!

          For practical exercises to learn more about Extreme Acceptance, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder

Coming soon in 2019!

 

 

 

 

 

 

 

*Linehan, M. M. 2015. DBT® Skills Training Manual, second ed. New York,: Guilford Press.
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Restoring Balance with Better Coping

In the previous blog series, we learned all about mindfulness.  In particular, we learned that applied mindfulness involves a three-step sequence: Awareness, Acceptance, Action. First we need to become more aware of what’s happening in the moment.  Then we need to become more accepting of what’s happening in the moment. And then, once we are both more aware and more accepting, we are in a much better position to finally take action:  In other words, to deal with the situation.

 

When we experience trauma, however, we are not using the part of the brain that guides us through awareness, acceptance, and action.  We are using a different part of the brain which is more concerned about our immediate survival. We are using the part of the brain that causes us to alter awareness, activate judgments—and jump straight to action as soon as possible.  But there are only three main options for action with this part of the brain: Fight, flight, or freeze.

 

The fight response means we become hostile or belligerent (whether physically, emotionally, or verbally).  

The flight response means we either physically leave or emotionally avoid a situation.  

And the freeze response means we just shut down altogether.  An extreme example of the freeze response is fainting.        

 

So what happens when you are in a situation in which it is not safe to fight back and it’s also not possible to escape?  That’s precisely why many trauma survivors learn to freeze—and then escape in their own minds. This is a process that psychologists call dissociation.  Dissociation is a combination of the freeze and flight response; this happens when you mentally freeze and then mentally escape, even if your body is still fully functioning and fully present in the situation.

All of these responses to danger or crisis are extremely helpful when we are experiencing a traumatic situation.  Awareness is altered because you need to focus only on survival. Judgments are activated because you need to make quick snappy decisions about life-and-death matters.  And you certainly do not have the luxury of consulting with a panel of experts on the best course of action. That’s why your brain limits your choices to the three options most likely to help you survive: fight, flight, freeze (which, as we saw, includes dissociation).

 

But here’s the problem…

 

When we have been traumatized enough, we learn to execute these responses to everything in life—even if we are not in immediate danger or crisis! In other words, our brains over-learn these responses.  Do you see the problem with that?

Let’s assume your coworker responds to you in a tone that you did not expect.  Now let’s assume your awareness is altered (you only notice her stressed tone, not her baggy eyes from not sleeping last night)…and then your judgments are activated instead of acceptance (“I can’t believe I have to work with scum that give me no respect)…and then you jump straight to fight, flight, to freeze.  I will let your own imagination take over from there. But here’s my point: Are you off to a good start at work? Did your trauma response just make things better—or a whole lot worse?

 

Remember that DBT is all about restoring balance?  DBT has entire set of skills called Distress Tolerance which are designed to provide temporary “quick fixes” to help us quickly restore balance in the moment, when we are triggered.  In other words, the purpose of these skills is to give us alternatives to replace our instinctive fight/flight/freeze reactions, and to get us back into our Balanced Mind as soon as possible.  

 

One of my favorite definitions of Distress Tolerance is “how to survive the moment without making it worse.”  In short, Distress Tolerance is all about healthier and more effective ways of coping—as opposed to unhealthy or ineffective coping, in which you hurt yourself, hurt someone else, or somehow make the problem worse than it already was. Another definition of Distress Tolerance that I really like is “turning unbearable pain into bearable pain.” Notice that Distress Tolerance does not take away pain—but it does help you deal with painful situations in ways that do not cause the pain to become even worse.

   

Ultimately, Distress Tolerance skills will help you with both acceptance and action.  That’s why the first Distress Tolerance skill you will learn is called Extreme Acceptance.  As you will see, Extreme Acceptance is a special kind of acceptance that we need to apply to both trauma and its consequences. However, after you learn about Extreme Acceptance, you will next learn a series of coping skills that will help you take action; in other words, learn how to react in more effective ways.

Notice that effective coping involves both acceptance and action. This is another one of the great balancing acts of DBT!

For practical exercises to learn more about your

fight, flight, freeze response, please refer to my new workbook: 

DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma

and Post-Traumatic Stress Disorder

Coming soon in 2019!

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Overcoming Blind Spots

So far in this blog series, we have further developed the themes of awareness, acceptance, and action. We have learned that we cannot accept difficult facts or make difficult changes until we first overcome our blind spots (denial and pre-contemplation). By definition, we cannot see our blind spots on our own…we need help from others to kindly, gently point them out. We have also learned other roadblocks for acceptance (anger, bargaining, depression), and have further learned that no action is lasting until we have found ways to maintain that change. And finally, we have also learned that acceptance is often a prerequisite for action. In other words, we won’t be motivated to change a problem if we haven’t first accepted that it is indeed a problem! 

But how do we get from acceptance to action? And how do we accept that something really is a problem? And how do we start to change something once we have agreed that it is problematic? The next exercise will help answer these questions!

 

Look at the following chart…

Problem Behavior:
  • Over-eating when I’m really stressed.
Positive Results
  • Short Term:  I love to eat.  I feel instant relief.  
  • Long Term:  Um, I can’t really think of any.
Negative Results
  • Short Term:  Immediately after over-eating, I start to feel nauseous, and then I can’t sleep.
  • Long Term:  I gain weight.  Then I have body image issues.  And my clothes don’t fit.
ACCEPTANCE

 Based on these results, is this behavior worth it?  Why or why not?

  • Based on these results, this behavior causes more problems than it solves.  While there are short-term benefits (I feel better in the moment), there are no long-term benefits.  In addition, the negative consequences are both short-term and long-term.
External Triggers
  • Who:  When I am alone.
  • What:  Watching TV.
  • When:  After stressful day of work.
  • Where:  In my bedroom.  

  What are your main external triggers?

  • My main external triggers seem to be when I am alone after a stressful day of work.  If I either have a good day at work, or I spend time with my husband processing the day, then I am much less likely to over-eat.  
Internal Triggers
  • Feelings:  Stressed.  Overwhelmed.  Worried. Anxious.  
  • Sensations:   My muscles start to tense.  My head hurts.
  • Thoughts:  I start to fantasize about my favorite junk food.

What are your main internal triggers?

  • Fantasizing about my favorite junk food is my main trigger.  There are other times when I feel stressed and overwhelmed, or my head hurts and my muscles tense, but I do not actually over-eat.   
ACTION How can I avoid, eliminate, or manage my triggers?

  • My job is sometimes really stressful, but that’s not really a trigger I can remove right now, because that would cause even more stress!  However, some of these other triggers can definitely be managed or replaced by finding other ways to unwind after a stressful day at work.  For example, instead of isolating in my bedroom and watching TV while fantasizing about junk food, I could go on a walk with my husband and process my day.   

First, identify a behavior that you would like to evaluate in more detail. Describe this action in as much detail as you need.

Then move to the next two rows. These boxes will help you accept whether or not this is a problem behavior. List all of the positive results that you can think of. Then list all of the negative results you can think of. Sometimes it is also helpful to distinguish between short-term positives versus long-term positives, as well as between short-term negatives and long-term negatives. Now take a step back and look at the rows describing the results of your behavior. Are there more positives than negatives? Are there more negatives than positives? Remember that this is not just about numbers. Sometimes just one long-term negative consequence can far outweigh many positive short-term consequences.

In the final analysis, are the negative results worth it? Or are there enough negative results to make this a problem behavior? In short, these boxes have just helped you with acceptance.

But now how do you change the problem behavior? Well, let’s take a look at the next two rows. These boxes are all about what preceded the behavior. The first of these two boxes is specifically about external triggers. External triggers answer questions such as: What? When? Who? Where? For example, what were you doing before the behavior happened? When was this going on? Who were you with? Where were you?

The next box is about internal triggers. Internal triggers answer questions like: What was going through your mind before the behavior happened? What were you feeling (emotionally)? What were you feeling (physically)? Guess what? Everything you just identified in these two boxes are called triggers! One of the keys to changing behavior is learning to identify, avoid, eliminate, or manage our triggers.

 

Do you see how this simple exercise helped you with both acceptance and change in one single chart?

 

For practical exercises to overcome your blindspots, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disordercoming soon in 2019!  

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Levels of Awareness

Have you ever noticed something about someone else before that person did?  Maybe that person has a funny tic or says the work “like” way too many times in one sentence.  On the flip side, have you ever thought that other people might notice things about you that you don’t even realize about yourself?

 

In this blog, we are going to talk about four different zones of awareness (Davies, 2014):

Zone 1:  Information that others know about me AND information that I know about myself.

Zone 2:  Information that others know about me BUT information that I do not know about myself.  

Zone 3:  Information that I know about myself BUT information that others do not know about me.

Zone 4:  Information that others do not know about me AND information I also do not know about myself.

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Zone 1 refers to general or public information, since this is information that both you and others know about.

For example, most people within your social circles probably know your name, your job, where you live, how many kids you have, and so forth.  Zone 1 is usually the stuff of small talk.

 

Zone 2 refers to blind spots; this is information that other people know about, but you do not!  As uncomfortable as this may seem, everyone has blind spots. We simply cannot observe ourselves from the same perspective as everyone else.  Even when we look in a mirror, we still cannot see ourselves to the same extent as someone else looking at us. Therefore, people end up observing details about us that we do not even realize.  Blind spots become a major issue in our lives when we have problems that other people see—but we do not. Trauma survivors can have unique blind spots. For example, some of your reactions may seem like over-reactions to other people.  Or some of your triggers may seem illogical to other people. Or some of your intense emotions may seem out of proportion to other people. Later on in this series, we will examine two kids of blind spots in greater detail: denial and pre-contemplation.      

 

  • One goal of this blog series is to help you identify your blind spots!

 

Zone 3 refers to hidden information, since this is information that you know about, but others do not.  Not here’s the tricky part about hidden information: Some information is just personal and we should keep it private, because other people don’t need to know our business.  However, some information is toxic when we keep it private, and we should share this information with someone that we can trust. In other words, there is a difference between healthy versus unhealthy secrets.  Examples of unhealthy secrets include any past or present abuse, neglect, or trauma.  We were not designed as people to carry these burdens alone!

  

  • Another goal of this blog series is for you to identify any traumatic experiences (either past or present) that you need to process!

 

Zone 4 refers to the unknown; this is information that nobody knows about—yet!   However, as you continue to journey through this blog series (as well as life), information from this zone will start to transfer to the other zones we have talked about.  

                            The more you practice the skills in this series, the more you will learn about                            yourself, and the more others will learn about you as well!

For practical exercises to learn more about the four levels of awareness, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder…coming soon in 2019!

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