Finding growth in the aftermath of post traumatic stress disorder

At 15, Angie Haag's behavior abruptly changed. She alternated between feeling numb and acting out with risk-taking behavior. Her grades slipped, she couldn't sleep and she pushed her worried parents away.

Although she was unwilling to talk to them, she did open up to the therapist they found for her, revealing that she had been raped by an acquaintance.

"I had held that secret," said Haag, now 32 and living in St Paul. "I was a child, I didn't have resources to process the trauma. The therapist taught me skills to manage my PTSD symptoms and that saved my life. I hate that I was raped, but it gave me an opportunity for more self-awareness, healing, growth."

As it turns out, Haag's experience of growth born of trauma might be more mainstream than miraculous.

A traumatic experience — especially one that is ongoing or historical — can result in post-traumatic stress disorder or PTSD. But many people who experience a traumatic event come out with what psychologists call PTG, post-traumatic growth.

A review of 26 post-traumatic growth studies published in the Journal of Affective Disorders found that about half of the people who experienced traumatic events reported "a moderate-to-high growth response."

"The growth experience isn't the flip side, it coexists with the misery of trauma," said Richard Tedeschi, professor emeritus of psychology at the University of North Carolina at Charlotte. "It doesn't make everything great. People experienced something terrible and grieve the loss. But we have to pay attention to the whole picture. We have tended to look at the worst part and have ignored the other part."

A licensed therapist, Tedeschi and a colleague identified the post-traumatic growth concept in 1995, following a decade of research and clinical work with trauma survivors. Since then, they've continued their scholarly work on PTG, publishing books on the topic and training mental health professionals.

Trauma, Tedeschi has concluded, can be the catalyst for new and positive possibilities.

"Trauma shatters a person's understanding of their world. Whatever they believed doesn't hold anymore. They can't go back to their baseline. They have to come up with a new version of who they are," he explained. "That process yields change, transformation. It's messy and painful, but that's where we see growth."

When growth occurs in the aftermath of PTSD, Tedeschi said, it gives survivors a greater appreciation of life, deeper compassion for others who suffer or a feeling that if they could survive their trauma, they can endure anything else that may come their way.

Taking power back

There are different forms of PTSD that bring people to counselors, psychologists and therapists in search of ways to cope and manage their symptoms, which often include intrusive memories, mood disturbances and persistent negative emotions, hypervigilance and sleep disorders.

"Trauma that originates with a single event is by far the most manageable to work with," said Kelsey Thomas, a Minneapolis licensed marriage and family therapist who specializes in trauma-informed care. "An example we use is someone who was in the 35W bridge collapse. Their world in general felt safe, but something scary happened so now they're not sure."

More complicated, she said, is her therapeutic work with clients who have experienced chronic, complex or historical trauma.

"I attract clients who are marginalized — women of color, trans, queer, disabled, multiracial, immigrants. They suffer the existential pain of being in a world that isn't safe for them," she said. "I don't tell them, 'Think positive.' Their pain is so much bigger than that."

Yet, Thomas has seen some of those clients learn to "take their power back" and experience PTG.

"I'm learning that post-traumatic growth is a way for people to have hope beyond the PTSD diagnosis," she said. "When the future becomes appealing and interesting, that's a huge thing. There is incentive to heal."

A desire for redemption

People have suffered from traumatic events since the dawn of time, but the concept of post-traumatic stress is a relatively modern one.

In 1980, the American Psychiatric Association added PTSD to the classification of disorders used by mental health professionals.

It differentiates the shattering impact of witnessing or experiencing life-threatening events like combat, torture, physical and sexual assault and natural and human-made disasters from life's painful but more predictable stressors — disruptions and hardships caused by serious illness, financial setbacks, divorce, deaths of loved ones.

Patricia Frazier, psychology professor at the University of Minnesota and director of the university's Stress and Trauma Lab, has spent her career studying trauma and its aftermath. She is skeptical that post-traumatic growth is as pervasive as the 2019 study reports.

"The idea that people grow from trauma is a very appealing notion. The research element is not as strong as the popular belief," Frazier said. "There's a story in our culture about redemption and post-traumatic growth fits that story. The downside is, people feel they're supposed to have this big transformation."

Frazier said that research on post-traumatic growth relies on an individual's retrospective report on their growth. In her experience, she's found that people can be notoriously unreliable in such self-assessments.

She also cautions family and friends of people suffering in the aftermath of a traumatic situation to resist the urge to talk in cliches about silver linings.

"We don't want to put this expectation out that there's something wrong with them if they don't experience growth," she said. "No one wants to see a loved one suffer, so there's a tendency to try to come up with some positives. That's perceived as minimizing, and minimizing is unhelpful. It's better to just listen."

Pandemic trauma

The past year and a half has thrown difficult obstacles into many lives. Many mental health professionals are struggling to keep up with the unprecedented number of people seeking help.

For some, the unrelenting stress of the pandemic has escalated into trauma that will linger: the front-line medical staff unable to save patients in crowded COVID wards; family members who watched loved ones die alone; people whose lives were untethered by the unexpected loss of jobs, businesses or homes.

"With the pandemic, we've liked to say we are all in this together, but we are not, really," said Tedeschi. "Some have been hit a lot harder than others."

Tedeschi and other researchers have begun studying the traumatic impact of the pandemic even as it drags on.

"Who will fare well depends on a number of things — how much other stress are they under, how healthy are they, can they find people who understand what they've gone through as they pick through the aftermath," he said. "It can take months or years to come to terms with these types of events. It's not so simple."

Stronger and healing

Angie Haag's experience with post-traumatic growth led her to her profession.

"My therapist showed me that I could mange my symptoms and still live. That first experience made me interested in psychology," she said. "I fell in love with healing and wanted to work in the field."

Now a therapist herself, Haag is president of the Minnesota chapter of the American Counseling Association. She facilitates trauma groups in her private practice and works in a hospital ER to provide crisis assessments for people who arrive with mental health issues.

"Trauma changes how we show up for life. I can't say what would have happened to me without therapy, if the trauma had kept driving my bus," she said. "I know that I'm stronger in my healing, more aware, I have better boundaries. I like my life like it is now."