“Trauma doesn’t have to defeat you. It can be a perfect opportunity for growth. Don’t just make a comeback. Use it as a catalyst forward.” – Matt McWilliams

What doesn’t kill you makes you stronger.

I’m sure you’ve heard this saying before. Maybe you totally agree with this statement, either due to personal experience with self-improvements and positive development after adversity, or seeing it happen with someone you are close to. Or, maybe you view it with some skepticism – after all, there are some experiences that surely could never leave stronger, healthier, and more capable people in their wake, right?

According to the latest research in positive psychology, the statement has a lot of truth to it. Enormous growth and development has been observed after unimaginable suffering, trauma, and pain.

While self-inflicting or volunteering oneself for suffering is certainly not a foolproof recipe for development, it is absolutely possible to channel the pain from a Traumatic event into positive, productive, and meaningful growth.

What Is Post-Traumatic Stress Disorder (PTSD)?

Post-Traumatic Stress Disorder, or Ptsd, is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event (NIMH, 2016).

The symptoms of PTSD can vary, but generally fall into one of four categories:

1. Intrusive memories
2. Avoidance
3. Negative changes in thinking and mood
4. Changes in physical and emotional reactions, or arousal symptoms (Mayo, 2017)

Symptoms that fall under intrusive memories can include:

• Recurrent, unwanted, and distressing memories of the traumatic event
• Reliving the traumatic event as if it were happening again (i.e., flashbacks)
• Upsetting dreams or nightmares about the traumatic event
• Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Avoidance symptoms include the following:

• Trying to avoid thinking or talking about the traumatic event
• Avoiding places, activities, or people that remind you of the traumatic event

While avoiding reminders of a traumatic event is a common and typically benign experience, it becomes a potential PTSD symptom when it interferes with your ability to function in your day-to-day life.

Negative changes in thinking and mood can include:

• Negative thoughts about yourself, other people, or the world
• Hopelessness about the future
• Memory problems, including not remembering important aspects of the traumatic event
• Difficulty maintaining close relationships
• Feeling detached from family and friends
• Lack of interest in activities you once enjoyed
• Difficulty experiencing positive emotions
• Feeling emotionally numb

Finally, the fourth category includes the following symptoms:

• Being easily startled or frightened
• Always being on guard for danger
• Self-destructive behavior, such as drinking too much or driving too fast
• Trouble sleeping
• Trouble concentrating
• Irritability, angry outbursts, or aggressive behavior
• Overwhelming guilt or shame

In addition to these symptoms, young children may also experience the following symptoms:

• Re-enacting the traumatic event or aspects of the traumatic event through play
• Frightening dreams that may or may not include aspects of the traumatic event (Mayo, 2017)
• Wetting the bed after having learned to use the toilet
• Forgetting how to or being unable to talk
• Being unusually clingy with a parent or other adult (NIH, 2016)

To be diagnosed with PTSD, the individual must be experiencing the following symptoms for at least one month:

• At least one re-experiencing or intrusive memories symptom
• At least one avoidance symptom
• At least two cognition/thinking and mood symptoms
• At least two arousal or reaction symptoms

Not everyone who experiences a traumatic event will go on to develop PTSD, but it is certainly not an uncommon diagnosis. Roughly 7 or 8 people out of every 100 will experience PTSD at some point in their lives, including about 10% of women and about 4% of men (National Center for PTSD, 2016).

The chances of developing PTSD increase dramatically for members of the military and veterans; between 11 and 20% of recent American veterans experience PTSD in any given year, while an estimated 30% of American veterans of the Vietnam War experienced PTSD in their lifetime (National Center for PTSD, 2016).

Sexual assault is also a common cause of PTSD for both men and women, although women are more likely to experience sexual assault, as well as being more likely to experience PTSD after sexual assault (National Center for PTSD, 2015).

Overall, about 7.7 million Americans who are 18 or older have PTSD (ADAA, n.d.). With so many people suffering from PTSD, there is a huge demand for resources to help those diagnosed with PTSD deal with their symptoms and, hopefully, reduce or eliminate symptoms altogether. Luckily, there are many resources available and several evidence-backed methods for treating PTSD.

 

What Is Eye Movement Desensitization and Reprocessing (EMDR)?

One such method for treating PTSD is called Eye Movement Desensitization and Reprocessing, or EMDR. This treatment is a relatively new one, but its efficacy is backed by a large body of research.

In layman’s terms, EMDR is a type of therapy that helps people heal from the symptoms of their trauma by harnessing the brain’s natural processes associated with memory and internal associations (EMDR Institute, 2017). The theory behind this therapy is called the adaptive information processing, or AIP, model, and it posits that some traumatic memories may remain unprocessed due the emotional disturbance attached to them. The memory can be linked to fragmented emotions, negative cognitions, and physical sensations that make the individual feel like they are reliving the event (Good Therapy, 2017).

The aim of EMDR therapy is to effectively process the fragmented memory and reduce its impact on the individual. It is an eight-phase treatment, with the phases generally progressing as follows:

1. Phase One: The treatment kicks off with one or more history-taking sessions, in which the therapist and client discuss the client’s current issues, past trauma, and the development of specific skills and behaviors that will aid the client in healing and growth.
2. Phase Two: The therapist ensures the client has several different ways to handle emotional stress, and may teach the client imagery or stress reduction techniques the client can use in and out of therapy.
3. Phases Three – Six: A target memory is identified and processed. The client identifies three things: (1) the vivid visual image related to the memory, (2) a negative belief about the self, and (3) related emotions and body sensations, as well as a positive belief to replace the distress from thinking about the traumatic event. The client focuses on these three things while engaging in EMDR processing, which can include eye movements, taps, and/or tones.
4. Phase Seven: In the closure phase, the therapist instructs the client to keep a log of any distressing event or memory-related material that may arise.
5. Phase Eight: In the final phase, the therapist and client discuss the progress that has been made so far and discuss further treatment (EMDR Institute, 2017).

This therapy has shown to be incredibly effective for people struggling with the symptoms of PTSD, including sexual assault survivors, combat veterans, and witnesses of extreme violence. Studies have found that EMDR therapy alleviates or eliminates symptoms for anywhere between 77% and 100% of PTSD victims, with better rates of success for single-trauma victims than multiple-trauma victims (EMDR Institute, 2017).

This therapy, among other effective treatments for PTSD, can help a trauma survivor get back to his or her old self, or perhaps even to a new and improved version of his or her old self.

To learn more about EMDR, click here for a short but information-packed description of the theory, steps, and expected outcomes.

 

What Is Post Traumatic Growth (PTG)?

The idea of Post Traumatic Growth, or PTG, is a popular one – that survivors of traumatic events can not only heal from their trauma, but may actually grow into a stronger, more driven, and more resilient person because of their trauma.

According to the Posttraumatic Growth Research Group at the University of North Carolina at Charlotte, PTG can be understood as positive change resulting from an individual’s struggle with a major life crisis or traumatic event (2014).

This positive change typically manifests in one (or more) of five areas:

1. A sense of new opportunities or possibilities in life.
2. Improved relationships with others, whether with loved ones or with others who have suffered.
3. Increased mental and/or emotional strength.
4. Greater appreciation for life in general.
5. Spiritual or religious deepening, which may or may not involve significant changes in beliefs.

A Brief History of PTG Thinking

This phenomenon of growth after trauma has been observed for about as long as humans have been suffering – which is to say, always! The theme can be found woven throughout our religious texts, mythologies and stories handed down through generations, philosophical musings, literature throughout the ages, and in our more modern mediums of television and film.

PTG was formally recognized as a psychological theory in the mid 1990s when researchers Richard Tedeschi and Lawrence Calhoun officially proposed the theory (Collier, 2016).

Over the last two decades, psychologists have engaged in many studies of this theory and discovered some valuable truths about PTG, including:

• PTG tends to be stable over time.
• People high in openness to experience and extroversion are more likely to experience PTG.
• Slightly more women experience PTG than men.
• Those in late adolescence and early adulthood are more open to PTG than children and older adults.
• The ability to grow after trauma may be linked to gene RGS2, which is associated with fear-related disorders (including PTSD, panic disorder, and anxiety).
• Psychological stress and dysfunction predict PTG, but optimism and future orientation do as well (Collier, 2016).

While these findings are encouraging, it never hurts to view new theories with a dash of doubt. A study from 2009 found that, although many participants who had experienced a traumatic event reported growth related to the trauma, this growth was not always verified by actual improvements in functioning (Frazier, Tennen, Gavian, Park, Tomich, & Tashiro). PTG is certainly possible, but it may not be as widespread and easily achieved as some proponents of the theory believe.

Regardless, the theory has provided hope to countless people and spawned multiple resources and methods of facilitating healing and growth among those who need it most.

 

Stephen Joseph: A Positive Approach to Trauma Healing

One such method of facilitating growth was developed by Stephen Joseph, a professor at the University of Nottingham School of Education and registered coach. Joseph has spent decades studying human responses to trauma and the significant growth that can result from such trauma, and has helped many survivors to move through their trauma rather than move past their trauma, using their traumatic experience as a catalyst for significant positive change in their lives.

This approach to healing from trauma was developed using the oldest recorded thoughts on PTG from ancient philosophy and literature, findings from evolutionary biology, and the latest research in positive psychology. To learn more about Joseph’s success in helping survivors of trauma harness their suffering to become even stronger than before, you can find his book What Doesn’t Kill Us: The New Psychology of Posttraumatic Growth at this link.

 

Post Traumatic Growth in Practice: 4 Therapy Techniques

In 2011, United States Army Behavioral Science Officer Stephanie D. Nelson outlined a posttraumatic growth path (PTGP) for treatment of individuals suffering from PTSD. This treatment plan includes several techniques that the evidence suggests will aid those suffering from symptoms of PTSD, categorized into four chronological stages of treatment progression: (1) Deal, (2) Feel, (3) Heal, and (4) Seal.

The primary technique from each of the steps is described below.

Deal – Writing a Trauma Narrative

In the first step, therapists can assign the sufferer an initial exercise that will set the stage for the following steps and facilitate the healing process. This exercise is creating their trauma narrative.

The trauma narrative is the client’s telling of the story of their traumatic experience(s). They are often quite difficult to begin, as the emotions engendered by the original trauma can come flooding back as the sufferer recalls the details of the event(s), but it will get easier as the process goes on.

Clients should begin by focusing on the facts – the who, what, when, and where of the experience. Next, they can add the thoughts and feelings that arose during the experience. Once they are comfortable listing or describing their thoughts and feelings during the experience, they should move on to the most difficult or disturbing moments of their trauma. This will be difficult, but it is necessary to put together a comprehensive narrative of the trauma. Finally, the client should take what they have produced so far and wrap it all up and create a seamless narrative, in addition to adding a final paragraph about how they feel now, what they have learned, and if they have grown from the experience.

This exercise can be completed individually or with a therapist or counselor to guide the client through the difficult process. However the narrative is completed, the therapist should go over the exercise with the client once the narrative is finished (Therapist Aid, n.d.).

Feel – Exposure

As the name of the main technique used in this step suggests, this is where the client is exposed to the traumatic memory in order to connect the fragmented cognitive and emotional aspects and facilitate catharsis. Imaginal exposure therapy is applied in this step, in which the client reads his or her trauma narrative and the therapist guides the client through processing of the event.

The therapist will then help the client explore their emotional responses and themes that came up during processing, discussing the primary feelings associated with the trauma.

After the session, the client has some homework – he or she will go home and set some time aside each day to process through the traumatic experience, focusing on purging the emotional aspects of it. It will likely be emotionally challenging to dredge up these memories and tie some intense feelings to them, but that is where these emotions belong: with the traumatic experience that spawned them, rather than displaced onto the self or others.

Heal – Three Concepts and PTG Channeling

In step three, the focus is on helping the client put the pieces back together, but in a new and stronger configuration than before.

The therapist will emphasize three concepts to the client:

1. Freedom of choice – The therapist explains that, while the client did not choose to experience the trauma that led them here, they are in control of their choices going forward. The narrative therapy concept of “rewriting the ending” is discussed to help the client see that he or she can create their own path.
2. Finding meaning from the experience – The therapist discusses how the client can find meaning in their experience, however is appropriate and feasible for them.
3. The Hero archetype – Finally, the therapist walks the client through the transformative journey of the Hero archetype by telling stories, tying the client’s spiritual and cultural beliefs into the stories to make them more meaningful for the client. The client may benefit from hearing the many stories in which the hero undergoes significant trauma and becomes a better, stronger person from it.

Once these three concepts are discussed, the therapist can move on to teaching the client techniques from solution-focused therapy, a type of therapy that emphasizes goal-setting and goal-striving. This component is referred to as PTG channeling, as it focuses on the client channeling their emotional energy from reliving or avoiding the traumatic experience into productive, goal-oriented behavior.

Overall, this step is about the client extracting meaning from their experience and finding their own answers and solutions. The therapist may assign more homework as this step wraps up, instructing the client to go home and engage in one action that illustrates their shift from victimhood to posttraumatic growth.

Seal – The Mind as a Filing Cabinet

The final step of the PTGP involves tying up loose ends and putting the finishing touches on the reorganization of the traumatic memory.

The “mind as a filing cabinet” metaphor is a great one to use in this step. In this metaphor, the memory of the traumatic experience is likened to a file that is unorganized, scattered throughout the filing cabinet that is the mind. Instead of each component being neatly sorted with the others, they are separated into dozens of different folders with no rhyme or reason, making it confusing and potentially disruptive when one of them is inspected.

In the previous three steps, these components were identified, hunted down, and moved to the right folder, while a few new pages were added documenting the growth experienced through the process. This step finalizes the folder and files it away in the cabinet. It can be revisited in the future, but it is no longer anything more than another in the hundreds and thousands of files and folders that make up the cabinet.

At this point, the client is ready to move on to another disorganized file, if there is another file that is in need of reorganization. Whether the therapy will continue on to another file or not, the therapist should commend the client for all of his or her hard work over the course of therapy and encourage them to continue incorporating PTGP into his or her life. The client should leave feeling empowered over their trauma and ready to move forward with a new and improved perspective on life (Nelson, 2011).

 

6 PTG Worksheets (PDF)

If you or your clients are more hands-on learners, people who like to jump in with both feet, roll their sleeves up, and get to work, you may find the do-it-yourself nature of worksheets and handouts to be particularly helpful.

The following six worksheets are some of the most popular and most promising worksheets and handouts for those suffering from PTSD, especially for those who want to focus on posttraumatic growth, or thrive instead of just survive.

The Feeling Thermometer

This handout from Dr. Aureen P. Wagner offers therapists and clients a quick and easy guide to discussing how the client is handling their emotions, specifically those related to the traumatic incident.

It is a simple, one-page handout with an image of a thermometer and ten possible levels:

• Piece of cake!
• A little twinge.
• Just a little uneasy.
• Starting to bother.
• Not too good.
• Getting tough.
• Pretty tough.
• Really tough.
• Can’t handle it.
• Out of control! Ballistic!

This handout is an excellent place to start any therapy sessions, and it can be extremely helpful when walking a client through an experience that is difficult to talk about.

Post Traumatic Growth Inventory

The Post Traumatic Growth Inventory, or PTGI, was developed by posttraumatic growth researchers Tedeschi and Calhoun as a way to assess the changes that a trauma survivor may have experienced since the event.

It includes 21 statements on potential areas of growth and change, rated on a scale 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).

Statements are categorized into the five factors, or five areas in which PTG is most often observed.

The first factor in the PTGI is Relating to Others, and includes statements like:

• I have a greater sense of closeness with others.
• I am more willing to express my emotions.
• I have more compassion for others.

Factor Two is New Possibilities, with statements such as:

• I developed new interests.
• I established a new path for my life.
• I am more likely to try to change things which need changing.

The third factor is termed Personal Strength, and assesses change with statements like:

• I have a greater feeling of self-reliance.
• I am better able to accept the way things work out.
• I discovered that I’m stronger than I thought I was.

Spiritual Change, the fourth factor, is composed of only one or two statements, depending on the client’s beliefs:

• I have a better understanding of spiritual matters.
• I have a stronger religious faith.

The final factor, Appreciation of Life, is characterized by the following statements:

• I changed my priorities about what is important in life.
• I have a greater appreciation for the value of my own life.
• I can better appreciate each day.

You can read more about this scale at this link.

Task Planning and Achievement Record

This worksheet has a wide range of applications and can be a beneficial tool for just about anyone, but it may be especially helpful for encouraging clients to work on setting and striving for goals in the Heal step of the PTGP.

It is a very simple worksheet, with only two components. In the first column, the client is to list the task or goal they would like to achieve or accomplish. In the second through eighth columns, the days of the week are listed (i.e., Monday through Sunday).

For each day that the client completes the task or reaches their goal, they can record their success in the corresponding column.

If desired, they can also add more information, such as their rating of their distress at the time, their current mood, or an objective measure of their performance, like run time or score on an assessment.

To access this simple yet useful tool, you can click here to view it.

EMDR Cognitions

This one-page handout is a great complement to the practice of EMDR therapy. It can be used to guide clients into identifying and understanding their thoughts about the traumatic event(s) and how it affected the way they think about themselves.

On one side of the handout is a list of negative cognitions in four separate categories:

1. Self-Defectiveness
2. Responsibility
3. Safety / Vulnerability
4. Control / Choice

Under each category, several cognitions or thoughts are listed that a victim of trauma may encounter, such as:

• Self-Defectiveness
  o I am worthless.
• Responsibility
  o I should have done something.
• Safety / Vulnerability
  o It is not okay to feel or show my emotions.
• Control / Choice
  o I am not in control.

On the right side of the handout, the positive, opposite cognitions are listed. For example, the opposites of the statements above are:

• I am worthless. / I have value.
• I should have done something. / I did the best I could.
• It is not okay to feel or show my emotions. / I can safely feel and show my emotions.
• I am not in control. / I am in control now.

A therapist can use this worksheet to let clients know their thoughts about the trauma they experienced are not abnormal, but that they can and should work their way from the thoughts on the left to the thoughts on the right.

To see this resource, click here. 

Patient Imaginal Exposure Data Form

This worksheet can be incorporated into the Feel step of the PTGP, when the therapist is walking the client through imaginal exposure. The client may find it helpful to record their distress before, during, and after the imaginal exposure process.

The worksheet instructs the client to record their Subjective Units of Distress Scale, or SUDS, level immediately before and after experiencing imaginal exposure. The scale is from 0 (no distress) to 100 (extreme distress). The client is also given an opportunity to record their craving for a harmful substance on a scale from 0 (no craving) to 100 (extreme craving), if that is something they are struggling with.

On the left side of the worksheet, there is space for the client to record the date of their imaginal exposure session. On the right, there are three sections to record their SUDS and/or craving ratings:

• Before
• Highest During (or Peak)
• After

Recording these ratings can help clients note any progress they are making in reducing their distress or cravings, and help them find patterns if they are stuck.

You can view this worksheet at this link.

Overcoming Avoidance: Facing Your Fears

Getting over the tendency to avoid situations, people, places, and even thoughts that remind the client of the trauma is a very important step in overcoming trauma and growing from the experience.

This worksheet from Carol Vivyan can help the client identify their avoidant tendencies and come up with a plan to reduce their avoidant behavior.

First, the worksheet includes space for the client to write down anything that he or she fears and actively avoids, including situations; people; places; tv, radio, or internet sources; and thoughts, along with a distress rating on a scale from 0 (least feared or distressing) to 10 (most feared or distressing).

Next, the client is instructed to rewrite the list, only this time including the most feared or distressing item at the top of the list and the least feared or distressing item at the bottom of the list.

Once the list is organized, the worksheet directs the client to think about the least feared or distressing item, and come up with ideas for how to start facing it. It may help to break it down into smaller steps. The client should write down what comes to mind, including any smaller steps they have decided on, along with any coping strategies they may use while facing this fear.

A table is included for the client to use in this step, with three columns:

1. Feared situation
2. Steps I need to take to face the feared situation
3. Coping strategies I can use during the feared situation

Once the client has successfully completed this step for her or his least feared situation, the client should continue on for each item on the list. The process should begin with the least feared situation, then the second least feared situation, all the way up to the most feared situation.

To see this worksheet, click here. 

 

A Take Home Message

This piece outlined the symptoms and provided the facts about posttraumatic stress disorder (PTSD), identified some of the most successful methods for treating PTSD, and introduced the concept of posttraumatic growth (PTG), or recovering from trauma to find yourself at a new and improved baseline.

I hope you found this piece to be useful, and I hope it inspired you to believe in your own vast growth potential. No one looks forward to suffering, but in this life it is inevitable that you will experience suffering at some point. When you do find yourself struggling with trauma, grief, or pain, remember that you have the strength to not only overcome the obstacles in front of you, but to become a better and more purpose-driven person as a result.

What do you think about PTG? Do you believe that “what doesn’t kill you makes you stronger?” Have you tried any of these tools or techniques? Let us know in the comments!

Thank you for reading!

• References

  • ADAA. (n.d.). Understand the facts: Posttraumatic stress disorder (PTSD). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
  • Collier, L. (2016). Growth after trauma. Monitor on Psychology 47. [Online feature]. Retrieved from http://www.apa.org/monitor/2016/11/growth-trauma.aspx
  • EMDR Institute. (2017). What is EMDR? EMDR. Retrieved from http://www.emdr.com/what-is-emdr/
  • Frazier, P., Tennen, H., Gavian, M., Park, C., Tomich, P., & Tashiro, T. (2009). Does self-reported posttraumatic growth reflect genuine positive change? Journal of Psychological Science 20, 912-919. doi:10.1111/j.1467-9280.2009.02381.x
  • Good Therapy. (2017). Eye movement desensitization and reprocessing therapy (EMDR). GoodTherapy.org. Retrieved from https://www.goodtherapy.org/learn-about-therapy/types/eye-movement-desensitization-and-reprocessing
  • Mayo Clinic. (2017). Post-traumatic stress disorder (PTSD). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
  • National Center for PTSD. (2016). How common is PTSD? U.S. Department of Veterans Affairs. Retrieved from https://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp
  • National Center for PTSD. (2015). Women, trauma, and PTSD. U.S. Department of Veterans Affairs. Retrieved from https://www.ptsd.va.gov/public/PTSD-overview/women/women-trauma-and-ptsd.asp
  • Nelson, S. D. (2011). The posttraumatic growth path: An emerging model for prevention and treatment of trauma-related behavioral health conditions. Journal of Psychotherapy Integration 21, 1-42. Doi:10.1037/a0022908
  • NIMH. (2016). Post-traumatic stress disorder. National Institutes of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
  • Posttraumatic Growth Research Group. (2014). What is PTG? UNC Charlotte Department of Psychology. Retrieved from https://ptgi.uncc.edu/what-is-ptg/
  • Therapist Aid. (n.d.). Trauma narratives. Therapist Aid Therapy Guides. Retrieved from https://www.therapistaid.com/therapy-guide/trauma-narratives

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