Abstract

A growing number of studies have found that stressful experiences in life often have long-term positive effects on a person’s well-being (Aldwin & Levenson, 2005). In this term paper I explore the potential for growth that stress and learning to cope with it provide for human development. After discussing some examples of this phenomenon,  I review scientific literature written about stress-related and posttraumatic growth, focusing on the hypothesis that traumatic stress can be an impetus for personal psychological transformation. I discuss the domains of posttraumatic growth, the factors that seem to enhance it, and possible interventions for promoting positive change after personal trauma. In the discussion section I investigate the limitations and possibilities for future research in this field.

Stress, Coping, and Growth

Normally, we expect difficult situations to produce negative outcomes. Research shows that stress has various negative consequences; when a person’s well-being is threatened the body reacts with stress responses that, depending on the type, severity, intensity, and duration of the stressor, can seriously damage both body and mind (Lovallo, 2005).

Depression and posttraumatic stress are examples of dysfunctional behavior patterns that can develop after stressful events. Major psychological trauma may cause damage; sometimes physical symptoms such as sleeping problems, gastric symptoms, and immune disturbances emerge, in other instances a crisis can act as a catalyst for the development or exacerbation of diseases or psychological disorders (Lazarus & Folkman, 1984).

However, suffering and psychological distress can also be the sources of positive transformation and growth; life crises can facilitate positive as well as negative changes. Traumatic events can provide a springboard for people into greater personal growth (Shaw, Joseph, & Linley, 2005). Many, among them clinicians, have written about this phenomenon.

Posttraumatic Growth Stories

Professional athlete Lance Armstrong (2007) provides us with important insights into the lived experience of people who are confronted with life-threatening diseases. Armstrong described his experiences as he went through the process of stress, coping, and growth from the moment of diagnosis (testicular cancer) through operations, treatments, and tests to recovery. Suffering seemed to help him to view this process as a fight against cancer, a race he recognized from his cycling; the pain made him even more determined to win his life back.

Armstrong (2007) testified that cancer and the confrontation with death taught him essential lessons about life. It increased, for instance, his tolerance for the ambiguities of life, confronted him with the need to ask more of himself as a person, and forced him to seek a different ethic. Apart from the sense of personal growth he experienced after his confrontation with cancer, he saw his illness “as something that I was given for the good of others” and “an opportunity as well as a responsibility” (p. 382). After this traumatic event in his life, he felt a new sense of purpose and suspected that his experience gave him a shot at a second, inner, and better life.

Psychiatrist Viktor Frankl (1959) survived concentration camps in Second World War Germany. His entire family perished during the war and he lost everything. During his time in the camp, Frankl was exposed to intolerable conditions (e.g., hunger, cold, and bestiality) and the constant fear of extermination. The search for a way to preserve what was left of his life led him to the realization that the ability to choose his attitude was his last human freedom: he had to find a personal meaning in the suffering his life was reduced to. In his writings, Frankl refers to a quote from Nietzsche who once said: “He who has a why to live can bear with almost any how” (p. 126).

Frankl (1959) was convinced that, once an individual has found meaning, he/she has the ability to find creative ways to transform the negative things life confronts one with into positive or constructive aspects and make the best of any situation: this individual has conquered the capacity to cope with suffering. As such, a human being, even in extremely stressful or traumatic circumstances, is not seeking happiness per se, but rather for a reason to be (or become) happy.

Cardiologist Pim van Lommel and colleagues (2001) researched near-death experiences (NDEs). They did a prospective study in ten Dutch hospitals with 344 cardiac patients who were resuscitated after a life-threatening cardiac crisis and found that 18% of these patients could recollect and describe some conscious experience of the time during clinical death: a NDE. According to van Lommel et al. (2001), NDEs are reported in people with critical medical problems, but also in patients with serious depression, extreme fear, or even without evident cause, and the content of the NDEs and their effects seemed similar worldwide, across cultures and times.

At the 2-year and 8-year follow-ups, the life-change inventory assessments showed significant differences between the group of surviving patients with NDE and the group of surviving patients without NDE: people who had a NDE had less fear of death, were more interested in existential questions, and experienced an enhanced appreciation for social relationships. Remarkably, all patients, including those who did not experience a NDE, perceived positive changes: they felt more self-assured, more socially conscious, and more spiritual than before their cardiac crises.

Posttraumatic Growth

Richard Tedeschi and Lawrence Calhoun (2004) discussed posttraumatic growth (PTG), a concept they described as the process of positive psychological development that an individual experiences as a result of the confrontation with a stressful event. Research shows that many people experience PTG after extremely stressful circumstances such as bereavement, confrontations with life-threatening or chronic illnesses, disasters and war (Tedeschi & Calhoun, 2004).

The concept of PTG is not new. Many religions (e.g. Christianity, Hinduism, and Islam) regard suffering as a catalyst for the development of insight and wisdom (Linley & Joseph, 2004). The idea that life’s challenges produce endurance, and endurance in turn develops character, is a well-known lesson in many stories and myths in most cultures (Park, Cohen, & Murch, 1996).

The underlying explanation for this phenomenon, according to Tedeschi and Calhoun (2004), is that a traumatic event challenges significant and fundamental assumptions a person has about the world and their place in it.

Stress and Cognition

As a response to the stressful situation, the PTG process combines the necessity of emotional relief with a cognitive restructuring to adjust to a changed worldview. According to Carolyn Aldwin (2007), PTG is a consequence of the reevaluation of basic cognitive guides for living. Changes in life philosophy manifest in a different appreciation for daily experiences, a review of life priorities, and through greater spirituality (Shaw, Joseph, & Linley, 2005).

Aldwin (2007) provides a description of the PTG process in her book. During and after a traumatic experience cognitive structures (schemas) and processes that have guided a person’s thoughts, emotions, and behavior are overthrown. One’s safety is challenged because assumptions about controllability and predictability are suddenly in question. A person feels psychological distress since purpose, meaning, and other existential notions are threatened. The cognitive restructuring that follows this experience of schema destruction, can be experienced as growth when a person realizes that he/she has the opportunity to reevaluate these schemas and is thus able to incorporate new insights from the experience. This person emerges from the process with a new set of acquired abilities and insights to face life and its future challenges.

Tedeschi and Calhoun (2004) suspected that especially the affective components of the perceived growth, the insights gained from the process that go beyond the intellectual understanding, render the PTG into a transformative experience. The trauma itself is not seen as meaningful; it is rather that the trauma confronts a person with prior beliefs and goals that are no longer valid, and forces his/her to thoroughly reevaluate specific aspects from his/her life. The attempts at psychological survival make the traumatic experience, often especially in retrospect, into an invitation to grow as a human being. The traumatic events is not appreciated in itself, on the contrary, it is often seen as extremely distressing, but it still is valued for it significance in provoking insights or strengths that a person was not consciously aware of before the incident  (Tedeschi and Calhoun, 2004).

The affective engagement and quality of the insights distinguishes PTG from other learning experiences; it seems as if the prize paid for the survival process in terms of suffering somehow enhances the importance of the lessons learned. The perceived value the transformation represents seems to depend on the sacrifice made for it (Tedeschi & Calhoun, 2004). Seligman (2002) argued along similar lines when he wrote that an individual needs a certain level of challenge to feel invited to fully engage his/her personal strength and virtues, an engagement and commitment which seems essential to perceive an experience as worthwhile.

Measures of Posttraumatic and Stress-related Growth

Tedeschi and Calhoun (2004) defined stress-related growth as the “positive psychological change experienced as a result of the struggle with highly challenging life circumstances” (p.1).Three widely used measures of growth after stressful experiences are the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996), the Stress-Related Growth Scale (SRGS; Park, Cohen, & Murch, 1996) and the Changes in Outlook Questionnaire (CiOQ; Joseph et al., 2005).

Tennen and colleagues (2000) suspected that these measures are questionable because they doubted whether individuals have the ability to accurately self-report their trauma-related growth (e.g. personality change over a period of time) and whether perceived change will accurately reflect actual change. Furthermore, these authors suggested that, since recall of previous states might not be accurate either, prospective studies with longitudinal designs would be more appropriate to examine the predictors, dynamics, and outcomes of PTG. The research by Van Lommel et al.(2001), described in the first pages of this paper, is an example of such a study.

Park and Helgeson (2006) mentioned the importance of determining whether growth is viewed as a unidimensional or multidimensional construct. Is growth seen as a single overarching perception of positive change, or rather are there various domains of growth? As we saw earlier, although the areas of change seem to be quite divers, ranging from increased spirituality to positive changes in relationships and personal strengths, the underlying growth seems to be of a different character that could be described as a singular, and maybe even unifying quality. These authors pointed out that research should distinguish between authentic and illusory growth since the different types may arise from different processes.

Domains of Posttraumatic Growth

The Posttraumatic Growth inventory (PTGI, Tedeschi & Calhoun, 1996), which identifies five major domains of growth, was developed from extensive interviews with individuals who experienced major life crises. They are the common elements emerging from growth experiences these people reported in response to questions about the aftermath of the crisis they experienced. The five factors that define the major domains of PTG are: (1) a greater appreciation of life and an altered set of priorities, (2) more compassionate and intimate relationships with others, (3) an enhanced recognition of personal strength, (4) a new sense of possibilities and personal paths, and (5) spiritual (or religious) development.

Appreciation of Life, Altered Priorities

Many people who report PTG comment on how the struggle to survive inspired a greater appreciation of life in them. They feel that what happened has changed their priorities in life; what was important to them before the trauma has often become less so, and especially the little pleasures that, for instance, involve the love for people or nature, now deeply touch them. They report this aspect as a major shift in their perception and have the sense that their stance in life has transformed: they notice more beauty and meaning in things they had taken for granted before (Tedeschi & Calhoun, 2004).

The issue of no longer taking things for granted returns in many of the accounts of people with PTG. Seligman and Csikszentmihalyi (2000) use the metaphor of a fish who is unaware of the water it lives in to explain that people take love, happiness, and hope for granted and do not realize that these positive emotions are the conditions that allow them to live. Seligman (2002) discussed the concepts of gratitude, savoring, and mindfulness, which are highly relevant in this context, proposing that a person can develop these positive attitudes when they want to (make the conscious choice to) be happier with their daily lives. People with PTG seem to have made this choice.

Relationships

Most individuals who report PTG experience that their appreciation of their personal relationships has changed: they report how important it is for them to have loving and supportive interactions with others. An increased sense of compassion, and in general, a greater connection to others, is felt. PTG people feel that their ability to feel empathy has developed and they feel more inclined to be supportive and helpful to others (Tedeschi & Calhoun, 2004).

Personal Strength

Going through the struggle of living through a major life crisis leaves most individuals with a better sense of self-efficacy and strength. They realize that once they have coped with the difficulties that they faced, they can handle other situations even better. Their sense of mastery and personal competence has grown to include coping skills they did not know they possessed.

Paradoxically, the sense of strength is often accompanied by an increased awareness of one’s vulnerability (Tedeschi & Calhoun, 2004). This vulnerability however, is not always perceived as a weakness, but rather accepted as an existential aspect of reality they have learned to live with. The inner knowledge that they were able to conquer the trauma broadened their perspective on life to embrace both vulnerability and strength.

New Possibilities

Many people who are confronted with a major traumatic event find that their basic assumptions about their world and their place in it are scattered by drastically changed circumstances. Most people find that they are unable to function or continue with their lives as they did before, and often their dreams and specific goals are no longer attainable (Aldwin, 2007). 

One of the most transformational aspects of PTG is the realization that there are new opportunities to explore and new choices to make (Tedeschi & Calhoun, 2004). After a period of limitations, caused by the trauma, new paths are often chosen in a structures and conscious way with more consideration for one’s deeper desires and with more reflection about one’s strengths. After a traumatic event that shattered cognitive schemas, a person often chooses goals of a higher level that are more in line with what he/she truly values in life (Rothermund & Brandstadter, 2003). The changes made are often perceived as positive and in general viewed as a rewarding result from the PTG process.

Spiritual Development

Spiritual development is often perceived as a greater engagement with life and its fundamental existential questions (Aldwin, 2007). Case studies reveal that religious and spiritual beliefs can be helpful to people who are recovering from stressful events in their lives (Park, Cohen, & Murch, 1996). But a traumatic event can also lead to a deepening of religion or spirituality, and positive religious coping (e.g. intrinsic religiousness, spiritual forgiveness, or openness to existential questions) is typically associated with PTG, according to Shaw, Joseph, and Linley (2005). These authors conclude that evidence shows that, although in some the experience of trauma can destroy their religious beliefs, in most people religion (or spirituality) can provoke a psychological recovery by offering a framework for interpreting life’s challenges. A religion may provide a (new) philosophy of life that can be used to integrate the consequences of the traumatic event and bring order to the chaos of its aftermath.  

Factors that enhance Posttraumatic Growth

Personal accounts from people who went through various very traumatic situations often show that, in retrospect, individuals viewed the changes they were forced  to make to their lives as positive (Aldwin, 2007). There is a wide variety of highly challenging circumstances that are considered major events.

Examples of traumatic events are the loss of a loved one, critical medical problems, or accidents that threaten a person’s life or their ability to function normally. Assaults, terrorism, war, and disasters also fall into this category. Similar events happening to people in one’s personal circle are often also perceived as traumatic.

Personal Characteristics

Some personal characteristics or specific coping styles may increase the likelihood of PTG. Personal characteristics (e.g., optimism and extraversion) are important; it is how the individual copes with the stress he/she faces that determines positive versus negative outcomes (Monat, Lazarus, & Reevy, 2007).

Research outcomes show that extraversion and openness to experience are personal qualities that help people make positive use of their struggles with stressful events (Costa & McCae, 1992). Positive affect seems the most important element in the cognitive processing that occurs in the aftermath of a traumatic event (Aspinwall, 2005).

According to Aldwin and Low (2004), emotion regulation is an important component when predicting psychological growth after trauma: coping strategies that consist of positive action, instrumental as well as conscious emotion regulation, promote stress-related growth, whereas people who cope with negative actions that are based on aggression and manipulation, show increased vulnerability and increased feelings of bitterness.

Affleck and Tennen (1996) focused on three personality dimensions that merited additional attention when studying how people pursue their personal goals in the face of traumatic experiences: dispositional optimism, cognitive and self-complexity, and dispositional hope. In their professional opinion, a positive interpretation of the present (optimism) may lead to a hopeful view of the future, and since optimistic expectations are closely related to benefit-finding and positive reframing, these traits are also helpful in extremely difficult situations.  These scientists emphasized the function of dispositional hope in perceiving positive aspects in living with the limitations of, for instance, a chronic illness, pain, or bereavement; hope being a construct based on the perceived attainability of desired goals. They discussed the key role hope plays in using convictions of benefit as a daily cognitive coping strategy in order to content with daily suffering. Furthermore, Affleck and Tennen (1996) argued that a person with a more complex conceptual system, in other words a more cognitive complex person, may be better able to create alternative goals and pursue more flexible ways of achieving meaning; the threatening experience is transformed into an opportunity to change their goals in life, their values, and even their priorities, in a conscious way. Hope, last but not least, is a construct based on the perceived attainability of desired goals.

Normally, a person has a complex of assumptions (beliefs) about the world and his/her place in it. Many people also have ideas about what is most important to them, what they want from life, and where they want to go (goals and directions). A traumatic event can confront an individual with severe limitations. The circumstances have radically changed and previous assumptions and goals are no longer valid. The discrepancy between the actual situation and the desired one that was based on former assumptions and goals is a factor that influences the response to traumatic events (Carver, 1998). This researcher found that self-confidence, the confidence a person feels about his/her ability to handle the situation, is an important factor that determines whether a person engages in active discrepancy-reducing coping behaviors and grows from a highly stressful experience or rather gives up.

Cognitive Processing

A traumatic experience often necessitates a revision of the person’s life story; the general framework a person has for thinking about his/her life. The process of growth, set in motion by the experience of some major trauma, challenges this narrative. Tedeschi and Calhoun (2004) emphasized the importance of the cognitive process, the cognitive engagement and willingness to develop wisdom about life, and the willingness to make modifications to one’s life narrative.

In the first period after the incident, typically the cognitive processing will be characterized by negativity, intrusive thoughts and feelings of despair and loss, psychological distress, and negative rumination. In a next stage however, a healthy person will tend to start to disengage from old and no longer valid beliefs and goals, and begin the process of cognitive restructuring that can eventually lead to psychological growth (Tedeschi & Calhoun, 2004).

Distress seems to keep the cognitive process active. When assumptions and goals  are not congruent with reality and no longer match the actual situation, stress occurs and a person is triggered to cope with the situation. This deviation-reducing mechanism is fueled by the distress the discrepancy provokes (Aldwin, 2007).

People have to be willing to give up certain basic assumptions or specific goals that are no longer valid, in order to grow after a traumatic event that has disrupted their prior way of life. At the same time, they have to engage in rebuilding new cognitive structuring. This may be an extremely difficult process. The persistence in cognitive processing is an important factor that is strongly associated with PTG (Nolen-Hoeksema et al., 1999).

In the literature, persistent cognitive processing is often described as negative; rumination is often associated with negative affect and depression (Nolen-Hoeksema & Larson, 1999). However, although the common use of the term rumination seems to describe rather negative or even self-destructive and repetitive thinking, rumination can also have a positive, healing, and growth-provoking function. Intrusive thoughts and repetitive internal questions can be quite disturbing and distressing, but they can also be seen as catalysts that propel a person into growth and gives him/her an orientation towards the future. Rumination often provides more comprehensibility, and offers the opportunity for revision of basic understandings with aspects including new principles, acceptance of new limitations, and a definition of self as a survivor (Nolen-Hoeksema et al., 1999).

Martin and Tesser (1990) noted that ruminations can help a person to solve problems, make sense of a situation, and gain insights. Cognitive processing, used here as synonym for rumination, involves a reflection on the disparities between prior assumptions and the new reality, between prior goals and a person’s new limitations. The trauma itself is the turning point: the person needs new assumptions and goals to replace the old ones that are no longer attainable.

Antecedents of PTG

What are the conditions that make PTG possible? Tedeschi and Calhoun (2004) mentioned (1) psychological distress induced by the trauma, (2) an important challenge to essential cognitive structures regarding self and the environment, and (3) intense processing on a cognitive level. All three imply and active emotional engagement with the stressor. Stanton and Low (2007) argued that personality attributes like optimism and hope, and the experience of positive emotions may also play a pivotal role in PTG. Benefit finding predicts better adjustment across time, according to these researchers, and positive mood is an important longitudinal predictor of positive health. In their studies, most (83%) women diagnosed with early-stage cancer perceived at least one point of growth (benefit) from their traumatic experience.

Flexible Goals

Often assumptions and goals are directly related to a person’s sense of identity and purpose. When after a traumatic event, reality can no longer accommodate the former beliefs, instead of blocking out the new reality, the traumatized individual needs to adapt to the new circumstances. A disengagement from the unattainable goals, or flexibility, is necessary in order to create an opening into new perspectives and potentiality (Aldwin & Low, 2004).

Paule Miquelon and Robert Vallerand (2006) argued that a shift people feel as transformative, reflects the change from pursuing a more or less controlled goal (born from internal and external pressures) into an orientation towards far more autonomous goals. Autonomous goals fall in the domain of self-realization and thus articulate positive functioning based on personal convictions. Self-realization allows a person to use more adaptive forms of coping. Qualities that enhance self-realization are for instance self-acceptance, purpose in life (e.g., having goals and objectives that give meaning and direction), positive relations with others, mastery and autonomy, and a sense of personal growth (Miquelon & Vallerand, 2006).

The perception of moving forward, towards achieving one’s goals is important for a person’s well-being (Seligman, 2002). Giving up dreams and expectations is accompanied by suffering and psychological distress, the acknowledgement and acceptance of their unattainability however, is ultimately experienced as liberating (Aldwin, 2007). The ensuing adaptation and transformation of these dreams and expectation into a new and more realistic image of future potential is often experienced as rewarding.

             Positive Affect

Positive affect (PA) is considered an essential aspect of happiness and refers to an active engagement with the world that is perceived as pleasurable (Miquelon & Vallerand, 2006). Ryan and Decy (2001) defined well-being (in the eudaimonic view) as a developmental concept: living as a complete human being is sought through the realization of valued human potentials. In other words: the worth of one’s life is measured in terms of qualities that a person can attain through conscious effort (self-realization). It seems that some of the domains Tedeschi and Calhoun (2004) mentioned as typical for PTG (see pp. 8-11), belong to the categories that fall within the valued human potential range Ryan and Decy (2001) are describing. Furthermore, the shift these scientists describe from the hedonic perspective (claiming well-being is subjective; happiness) toward the eudaimonic perspective on well-being (focused on psychological well-being; happiness plus meaning) may well be at the core of the transformative process people perceive as growth after a traumatic experience.

In stressful situations, positive emotions often accompany distress. Positive affectivity contributes to posttraumatic growth in psychological resources such as belief in positive outcomes, satisfaction with life, and tranquility, but also enhances psychological resilience (Aspinwall, 2005). Stanton and Low (2007) suspected that positive emotions may well enlarge one’s capacity for PTG, as the ability to find benefit and positive meaning (growth) can in turn engender the cultivation of positive emotions.

Three basic psychological needs that are the foundation of well-being are autonomy, competence, and relatedness (Ryand & Deci, 2000). Carver and Scheier (2000) discussed how these three core needs could be described as the “how” of a person’s behavior in terms of behavior done freely and behavior done well, and the “what” of this behavior, that needs the environment and people to interact with to optimally adapt to circumstances. In their view, proactive discrepancy-reducing behavior, supported by positive affectivity in relation to autonomy, competence, and relatedness,  creates and maintains congruency and is extremely important in stressful situations. 

Will to Live

Another important factor in the process people face when dealing with a traumatic (life-as-you-know-it threatening) experience is the confrontation with death. As Seligman and Csikszentmihalyi (2000)  suggested with their fish in the water metaphor, most people take life for granted. When faced with death, or the death of a loved one, a person suddenly realizes how much life and living mean to him/her. This realization in itself can transform a person’s perspective and engender an appreciation for life, relations with others, and the world in general. The confrontation with loss can be a powerful wake-up call (Armstrong, 2007). As a clinician Frankl (1959) sometimes boldly asked his patients why they did not commit suicide. The answer the patient gave to this question was often the key to his existential psychotherapy (logotherapy).

Interventions to promote PTG

Therapeutic interventions are most often focused on assisting patients to cope with stressful situations. It would be interesting though, to develop interventions that not only reduce the stress, but also enhance the opportunities for growth that the situation, ultimately, provides. Of course an appropriately individualized approach and careful timing are called for. Stanton and Low (2007) cautioned that interventions that focus too much on PTG may also engender an expectation of psychological growth that could be counterproductive when it would be perceived as prescriptive. These authors suggested sensitivity concerning timing and framing of interventions.

Social Support

Social support, sharing experiences with concerned others, and adequate information are essential factors during challenging times (Lechner & Antoni, 2004). Support group interventions are an effective way to revise schemas, provide participants with models of people with similar traumas who are reporting growth, and can serve as a safe haven in which the patient does not feel alone but cared for in his/her suffering or struggle. In his story, Armstrong (2007) gave testimony of the need for social support he felt (e.g., from his family, friends, and physicians) in coping with his illness. Contact with others who shared his disease proved to be helpful to him too.

Social feedback and interaction with loved ones also provides a way to brainstorm about the new limitations and possibilities and provides the platform to obtain different perspectives on one’s situations. Mutual support, for instance in support groups for people with the same traumatic experience, can be especially helpful for trauma survivors who will feel more willing to accept the views from people who suffered similarly (Neimeyer, 2001).

Self-disclosure in a supportive social context, corresponding with others, and other forms of deliberate cognitive processing soon after the trauma, also seem to have beneficial effects on the PTG outcomes (Ulrich & Lutgendorf, 2002). Expressive disclosure, for example keeping a journal in which one writes about thoughts and feelings related to the traumatic experience, was found to be extremely helpful, especially when the client/patient was explicitly invited to also write about positive thoughts (Stanton & Low, 2007).

Ruminators tent to benefit more from social interactions since it helps them avoid depression; cognitive processing appears to be inhibited when the opportunity to self-disclosure is blocked or when social support is denied (Nolen-Hoeksema & Larson, 1999).

             Cognitive-Behavioral Stress Management

Lechner and Antoni (2004) discussed clinical interventions that may promote PTG. These authors researched cognitive-behavioral stress management (CBSM) interventions, some in supportive group settings, for a variety of patients in stress-related situations, and found significant positive outcomes for PTG. CBSM interventions were positively associated with lower blood levels of cortisol, which seemed to be mediated by reported PTG, and faster recovery rates of the patients’ immune systems.

Elements of CBSM identified as especially relevant in facilitation PTG are enhancing hope and optimism, teaching cognitive and adaptive coping skills (e.g., reframing, proactive coping), encouraging acceptance, and inviting self-reflection and self-disclosure. However, the ability to measure PTG accurately is limited and future research must focus on developing assessment methods that can distinguish true growth from pseudo growth (Park, Cohen, & Murch, 1996).

Adaptive  Coping Styles

According to Aldwin (2007) a person’s coping style is plastic and develops in the course of a lifetime while dealing with changing circumstances and stressful situations. This also means that people can learn to cope differently and that interventions, for instance during psychotherapy, could be aimed at the development of more adaptive coping styles.

An example of how adaptive strategies can change across the life-span is presented by Gutmann (1987), who found that the acceptance of problems and the resignation to them changes with age. This may be an incremental developmental process towards more mature coping styles that are characterized by greater social competence, higher levels of purpose in life, and for instance humor (Aldwin, 2007).

Rothermund and Brandstädter (2003) suggested that coping mechanisms tend to evolve from assimilative (problem-focused) to more accommodative coping styles, because the problems people are confronted with become more and more uncontrollable and thus emotion-focused coping strategies are considered more appropriate. Furthermore, later in life the need to expand one’s horizons is replaced by the increasing emphasis on deriving meaning from one’s experiences.

Often, people facing stressful situations are confronted with sudden decreases in physical and psychological energy levels. The declining sources of energy force them to use coping strategies aimed towards conserving energy. A realistic interpretation of the situation and the alternative responses allows the person to act in a more efficient way. The acceptance of one’s limitations, the recognition that withdrawal is a valid option, and the choice to be more selective, are adaptive strategies that can conserve scare resources (Aldwin, 2007).

Positive Psychology

Few people know what makes life worth living. Seligman and Csikszentmihalyi (2000) suggested that psychologists should focus (more) on positive subjective experiences, positive emotions and positive activities, because these experiences enhance well-being and health and should be nurtured. People can, in their view, learn to consciously choose to be more satisfied with their past, happier with their here and now, and be more optimistic and hopeful about their future. Seligman and Csikszentmihalyi (2000) distinguished between positive experiences that are pleasurable and positive experiences that are enjoyable. Pleasure comes from satisfying homeostatic needs, but enjoyment requires a breaking through the limits of this homeostasis and can lead to flow and personal growth. These researchers concluded that people are often blind to the survival value of positive emotions. In their view psychology could be the science that seeks to understand what makes life worth living.      

Positive psychology focuses on optimal psychological functioning. Miquelon and Vallerand (2006) researched the associations between positive behavior patterns and physical health. They suggested that, since pursuing autonomous goals is positively associated with well-being (happiness and self-realization), it is also positively associated with physical health.

Self-regulation

An interesting topic in the discussion about PTG is the question of free will and self-regulation. Although most psychological theories appear to be influenced by deterministic models, either driven by genetic or neurological givens, the transactional approach shows behavior as complex and dynamic composite of multiple elements (Aldwin, 2007). In a discussion about PTG, the question arises why some individuals are more inclined to experience positive personal changes in the aftermath of traumatic events while others seem to experience predominantly negative effects. Whereas life presents human beings with choices daily, these are often hardly noticed or made with a minimum of consciousness. The occurrence of a traumatic event however, confronts a person with a new reality (e.g., with the loss of a loved one), a threat (e.g., an illness) or chaos (e.g., a disaster or war) that cannot be ignored, and choices must be made.

Eccles and Wigfield (2002) defined a number of essential characteristics that are necessary for the development of self-regulatory processes: (a) self-awareness; a person must be able to monitor his/her emotions, thoughts and actions, (b) the ability to direct and sustain attention to what is deemed relevant, and (c) the individual must be capable to monitor, evaluate and adapt his behaviors and the reactions it evokes in and on the environment. These authors emphasize the need to include affective processes in the research into the reason why some individuals are motivated and choose to engage in proactive coping, adaptation, and/or achievement behaviors (in some cases leading to PTG), and others do not.

Stressful events can be seen as providing the necessary context through which development can occur: people are pushed to develop skills and capacities that are valued as admirable, sometimes the coping strategies that are specifically praised within their culture such as individuality and self-efficacy in western cultures, and compassion and altruism in eastern cultures (Aldwin, 2007). 

Discussion

Individuals who are confronted with traumatic events often perceive that they experience concomitant positive life changes (Stanton & Low, 2007). Because of their work with cancer patients, these researchers are convinced that from loss and struggle abundant gain can arise. Tedeschi and Calhoun (2004) use the term posttraumatic growth, rather than stress-related growth. They argued that only major negative stressors (in their metaphor seismic events) provide the incentive to provoke the life-altering changes they describe as PTG. Aldwin and Levenson (2004) however, prefered the concept of stress-related growth (SRG), because they suggested that stressful experiences often lead to change that, depending on stressor and individual factors, can be perceived as growth. These authors argued that even minor stressors can result in increased coping skills or closer ties with others, implying that less rapid or comprehensive growth (compared to PTG) is also growth.

Tedeschi and Calhoun (2004) considered concepts like resilience, hardiness, optimism, and the sense of coherence descriptions of personal characteristics, whereas PTG refers in their view to qualitative transformations that go beyond a personal tendency or ability to cope with stressors. It could well be that a person who is highly capable of dealing with stress reports relatively low levels of PTG, which would confirm the hypothesis that a certain amount of stress is needed to engender substantial transformation.

Major life crises, or rather the struggle to deal with the new reality these crises bring, can provoke changes. In that sense, traumatic events can present important challenges to an individual’s understanding of the world. But positive events can also have a developmental potential. Examples are childbirth, marriage, and profound religious experiences (Aldwin & Levenson, 2004).

Positive experiences can challenge schemas the way traumatic events do. Abraham Maslow (1968) for example, studied the accounts of people who experienced what they perceived as extremely positive, happy, and growth inducing instances/states of Being and calls these experiences “peak experiences” (p. 85). These peak experiences can be moments of love, intellectual insight, or mystic experience, but also creative moments, moments of aesthetic perception, or certain forms of athletic fulfillment. Maslow (1968) reported the positive aftereffects of peak-experiences, including therapeutic effects (e.g., removing certain neurotic symptoms), healthy changes of perspective (e.g., view of the world and of self), greater creativity, spontaneity, and expressiveness, and an increased appreciation of life. Life itself, he noted, seems validated by the peak experience, and suicide becomes less likely. It would be interesting to compare the effects of traumatic life events with the effects of peak experiences and gain insights about their similarities.

Tedeschi and Calhoun (2004) noted that each of the five domains of PTG seems to contain a paradox that is emphasized by the process the individual has gone through after the traumatic event in his/her life. Growth manifests when a person becomes aware that, for instance, out of loss they can learn what can be gained. When people are confronted with a limitation, they discover that other limitations they once took for granted, no longer exist. The sense of strength can grow from conquering extreme vulnerability and spiritual doubt can turn into faith in a higher dimension. The wisdom gained from the recognitions of these paradoxes is apparent in many of the trauma survivors.

Experimental studies could determine whether growth (measured by self-reports and external indicators of growth) can be manipulated and subsequently linked to health outcomes; these studies should elucidate how, and under which circumstances, growth experiences occur (Park and Helgeson, 2004). People who experienced PTG often report that they maintained their perception of adversarial growth over time and are ultimately less distressed by the traumatic event because of it (Linley & Joseph, 2004). In that sense the experience of growth resulting from the trauma is perceived as a “benefit” and serves as a way of cognitive coping with the new situation. This aspect of PTG would be interesting to study.

In her discussion about the importance of future-oriented thinking, Lisa Aspinwall (2005) emphasizes the possibility, or even the need, for an individual to consider imminent or future stress. Research into interventions created to teach individuals how to both cope with trauma and grow from the experience, could also be helpful for people who expect to be confronted with trauma (e.g., death of a spouse, an impending disability). Preparatory interventions would assist these individuals to engage in proactive efforts to best cope with the expected future trauma.

According to Affleck and Tennen (1996) benefit-finding is an important aspect of coping with adversity and its associations with psychological dispositions and personality traits is worth researching. The possible occurrence of profound transformations, seen in people who went through major traumatic life events, calls our attention to the potential of human virtues and strengths to surface when needed. Since most people who experienced PTG perceive this development as ultimately positive, it would be interesting to research how similar growth may be provoked without the traumatic experience, for instance through psychotherapeutic interventions.

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