Post-Traumatic Growth

Posttraumatic Growth (PTG) is a concept that describes positive psychological changes experienced by individuals as a result of struggling with highly stressful and challenging life crises such as serious illnesses like cancer, the loss of a loved one, natural disasters, war, sexual assault, or other life-threatening events. This concept goes beyond mere survival or returning to previous levels of functioning; it refers to a psychological transformation that leads individuals to reach a higher level of functioning than before the trauma. Growth manifests in both quantitative and qualitative changes among those who recover from trauma. However, experiencing posttraumatic growth does not imply that the individual did not or will not experience psychological distress; stress reactions and growth often occur simultaneously.

Definition and Conceptual Framework

Posttraumatic growth is a positive outcome that arises not from the trauma itself but from the difficult struggle it triggers. This phenomenon represents more than a coping mechanism; it is both an outcome and an ongoing experience. The concept examines scientifically a phenomenon that can be summarized by the saying, “What does not kill you makes you stronger.”

Posttraumatic growth is distinguished from similar concepts such as resilience, sense of coherence, and hardiness. While resilience refers to a dynamic process of effective adaptation under adverse conditions, posttraumatic growth signifies a qualitative transformation or change in functioning. Tedeschi and Calhoun (2004) note that individuals who demonstrate posttraumatic growth may experience higher levels of distress than those with high resilience^【1】.

Historical Development

The effects of traumatic events on human psychology have long been recognized. The etymological origin of the word “trauma” dates back to around 1500 BCE to Sumerian writings. Ancient texts contain the idea that difficult experiences and suffering could lead a person toward wisdom or a higher spiritual state. Elements of the transformative power of suffering are found in belief systems such as Hinduism, Buddhism, Islam, and early Christianity.

In psychological literature, trauma was long addressed solely in terms of pathological outcomes. Starting particularly in the 19th century, mental health issues caused by war and civilian disasters began to be studied. After World War I, the term “traumatic neurosis” was used; after World War II, diagnoses such as “combat neurosis” emerged from studies of survivors of concentration camps and soldiers. This process became systematic with the inclusion of Posttraumatic Stress Disorder (PTSD) in the American Psychiatric Association’s DSM-III in 1980.

Scientific interest in the positive outcomes of traumatic experiences emerged in the 1990s. Richard Tedeschi and Lawrence Calhoun became pioneering figures who systematically defined and researched the concept of posttraumatic growth.

Domains of Posttraumatic Growth

Tedeschi and Calhoun have indicated that posttraumatic growth typically emerges in five main domains. These changes are not confined to a single area but can manifest across multiple dimensions of a person’s life.

Greater Appreciation of Life and Changed Priorities

Confronting a traumatic event can lead individuals to recognize the transience and fragility of life. This awareness may prompt them to reevaluate their life priorities and derive greater pleasure from previously overlooked daily occurrences and small things.

Closer and Warmer Relationships with Others

During a crisis, individuals often seek support from family and friends. The experience of opening up about what happened and receiving support can result in increased closeness, sincerity, and perceived emotional bonds in interpersonal relationships. While some relationships may weaken, others may become more meaningful.

Increased Perception of Personal Strength

Successfully coping with a traumatic experience can help individuals recognize their own strength and capabilities. They may develop a mindset such as, “If I can overcome this, I can handle anything,” leading to greater self-confidence in facing future challenges. This sense of strength coexists with an awareness of vulnerability.

Recognition of New Possibilities

Trauma can shake an individual’s previous life path and assumptions, prompting them to discover new paths and options. They may set new goals previously thought impossible or redirect their lives toward new opportunities by changing their philosophy of life.

Spiritual and Existential Growth

Traumatic experiences can lead individuals to question their religious or spiritual beliefs and undergo development in these areas. For some, belief in a higher power may increase; even non-religious individuals may experience spiritual growth.

Theoretical Approaches

One of the key models explaining posttraumatic growth focuses on cognitive processes. According to this approach, trauma disrupts an individual’s fundamental assumptions about the world and themselves.

Janoff-Bulman’s Basic Assumptions Model

According to this model, people hold three fundamental assumptions to make sense of the world: that the world is fundamentally good, that the world is meaningful and just (people get what they deserve), and that the self is valuable. Traumatic events shatter these assumptions, leading individuals to perceive the world as dangerous, meaningless, and themselves as inadequate. Posttraumatic growth emerges as a result of the cognitive processing through which individuals reconstruct these shattered assumptions.

Planned and Unplanned Change Models

In the literature, models of posttraumatic growth can be categorized under planned and unplanned change. Planned change models typically describe transformation facilitated by interventions such as psychotherapy, while unplanned change models aim to explain changes resulting from uncontrollable external events such as the COVID-19 pandemic or natural disasters.

Factors Influencing Posttraumatic Growth

Posttraumatic growth is a complex process influenced by various individual and environmental factors.

Individual Factors

Personality traits are a significant factor influencing growth. Research shows that personality characteristics such as extraversion, openness to experience, and agreeableness are positively associated with posttraumatic growth. Problem-focused and emotion-focused coping strategies also show a positive relationship with growth, while strategies such as denial and suppression of emotions are linked to negative outcomes. Sharing emotions and thoughts about the trauma with others (emotional disclosure) can facilitate cognitive processing and contribute to growth.

Environmental Factors

Social support can play a decisive role in growth by influencing the coping process and adaptation to traumatic experiences. Sociocultural variables are also important. Some studies have found that women, younger individuals, and those with higher levels of education are more likely to report posttraumatic growth. However, findings regarding factors such as gender are inconsistent; some studies identify significant relationships while others do not.

Applications and Research Areas

The phenomenon of posttraumatic growth has been studied in relation to a wide range of traumatic events, including:

• Natural Disasters: Major earthquakes such as the 1999 Marmara Earthquake.
• Severe Illnesses: Life-threatening conditions such as cancer, HIV, heart attack, and bone marrow transplantation.
• Human-Caused Disasters and Violence: War, sexual assault, sexual abuse, terrorist attacks, hostage situations, and migration.
• Societal Traumas: Epidemics affecting entire populations, such as the COVID-19 pandemic.
• Personal Losses and Crises: Events such as the death of a loved one or divorce.

Measurement and Assessment

Various scales have been developed to measure posttraumatic growth. Some of the most commonly used scales include^【2】:

• Posttraumatic Growth Inventory (PTGI): Developed by Tedeschi and Calhoun (1996), it is the most widely used assessment tool in the field.
• Stress-Related Growth Scale (SRGS): Developed by Park and colleagues (1996).
• Changes in Outlook Questionnaire: Developed by Joseph and colleagues (1993).
• Perceived Benefit Scale: Developed by McMillen and Fisher (1998).