Can Trauma Improve Psychological Health?

Traumatic events are not necessarily traumatizing. In fact, traumatic events are usually not traumatizing. Most people suffer no enduring psychological consequences from them, even after events as horrific as the 9/11 terrorist attacks or a mass shooting. After decades of confusion about our capacity to cope with acute stress, we now know—based on study after study—that people have a robust and likely inherent capacity to cope effectively with trauma.

The Complex and Sometimes Paradoxical Effects of Trauma

My purpose here is not to review the evidence for resilience to trauma (see here for that). Instead, I want to suggest an even more radical idea: That trauma can—sometimes and for some people—have beneficial effects. Yes, beneficial effects.

My colleagues, Heather Littleton and Amie Grills, and I had an extremely rare opportunity to test this possibility in a study of 368 female survivors of the Virginia Tech campus tragedy in 2007, the second most deadly civilian shooting in US history. It was rare because students’ functioning (depression and anxiety symptoms) had been assessed before the shootings (as the result of an unrelated study) and again at 2, 6, and 12 months after. This allowed us to precisely gauge the impact of the shootings on their psychological health.

We expected to find a range of psychological responses to the tragedy, and we did. Most (about 60 percent) were resilient, with no statistically discernible uptick in distress after the shootings. On the other hand, about 20 percent of survivors saw large increases in anxiety or depression that continued to increase for 12 months—a reaction consistent with potential posttraumatic stress disorder. Given the typical prevalence of resilience and the indisputable potential of such events to generate distress, these findings were unremarkable.

What was remarkable was a group of survivors whose psychological health improved. This group had high levels of depression and anxiety before the shooting and substantially less anxiety and depression after the shootings. About 15 percent of the sample, in fact, saw substantial and statistically significant improvement in psychological functioning.

Social Relationships Can Be Strengthened after Traumatic Events

Why would some people improve? We hypothesized that people who felt isolated, anxious, and depressed before a traumatic event would benefit from a well-documented phenomenon: The power of acute stress to strengthen our relationships, particularly with close others. The UCLA psychologist Shelley Taylor has described this as “tend-and-befriend.” Indeed, for more than half a century, historians and sociologists have documented this phenomenon, variously describing the aftermath of mass trauma as a “post-disaster utopia,” a “city of comrades,” and “a democracy of distress.”

This is exactly what we found. Psychologically improved survivors reported a substantial increase in the belief that friends and family would be available if needed. They were more likely to report gains in intimacy with friends or family, and to perceive an increased sense, for example, that “I can count on my friends when things go wrong” and “I can talk about my problems with my family.” Remarkably, their social ties continued to strengthen for a full year after the shootings. As expected, the group with potential posttraumatic stress disorder reported no increase—and even a slight decline—in their perceptions of support from others.

“The Remedial Influences of Pure, Natural Human Relationships”

The trauma appeared to improve their relationships. And this in turn may well have improved their psychological functioning. Indeed, close and active social relationships are essential to well-being and happiness. Not surprisingly, then, psychological distress is exquisitely responsive to the quality of our relationships: The perceived absence of supportive relationships is one of the strongest predictors of posttraumatic stress disorder, a devastating and potentially chronic illness. All of this points to a fundamental and often overlooked reservoir of healing: what the novelist George Eliot once described as “the remedial influences of pure, natural human relations.”

References

Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, 20-28. doi:10.1037/0003-066X.59.1.20

Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2006). Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack. Psychological Science, 17, 181-186.

Mancini, A. D., Littleton, H. L., & Grills, A. E. (2016). Can people benefit from acute stress? Social support, psychological improvement, and resilience after the Virginia Tech Campus Shootings. Clinical Psychological Science, 4, 401-417. doi:10.1177/2167702615601001

Solnit, R. (2010). A paradise built in hell: The extraordinary communities that arise in disaster: Penguin.

Wolfenstein, M. (1957). Disaster: A Psychological Study: Free Press.

The Trouble with Post-traumatic Growth

You’ve probably heard of post-traumatic growth.  It’s been touted in the New York Times (“the surprisingly positive flip side of PTSD”), studied in countless empirical papers, and sermonized in TED talks, books, and academic research centers. It’s one of those zeitgeist ideas upon which entire empires are built: First, we had PTSD, but now we have post-traumatic growth.

The basic principle is this: Something horrendous happens (a mugging, a serious car crash, a cancer diagnosis), and in the weeks and months that follow, we have trouble not thinking about the experience. We avoid reminders of it, and we have intrusive memories that pop into our heads and ratchet up our anxiety. We are debilitated by these symptoms. But at some unspecified time later–perhaps years after–we grow from that trauma, and we become a better person. We become wiser, stronger, more accepting of others; we develop closer relationships and have more compassion for others; we change our philosophy of living, re-evaluate our priorities, and become more spiritual. All in all, we are better, because we were traumatized.

It’s an immensely appealing idea. Who wouldn’t want it to be true?

The only problem is: There’s very little evidence for it. Wait, didn’t you just say that countless empirical papers have been published on post-traumatic growth?

Yes, but here’s what almost all of those studies do. They ask people who have experienced a potentially traumatic event whether they are better off because of it. And what do you know, many people report that they are indeed a better person. They have grown. They see new possibilities in life. They are able to find in their suffering a bright kernel of redemption.

But does this mean they actually are better? In other words, are they actually wiser, more compassionate, and closer to others? Or do they just perceive that they are?

Perceived Growth and Actual Growth Are Two Different Things

It turns out that it is very difficult to separate these two things: the perception that we are better and the actuality that we are. In fact, almost no studies separate perceived and actual growth for a very good reason: It is extraordinarily difficult to know how someone is doing before a trauma occurs.

One remarkable study did just that: they measured a large sample of undergraduates (N = 1,528) at the beginning and the end of a semester. They then identified a group of participants who experienced a traumatic event during the semester that caused considerable distress  (n = 122). They asked whether they had grown from the trauma (including “I have a greater feeling of self-reliance” or “I am able to do better things with my life”). In theory, among this trauma-exposed group, if you perceived that you grew from the trauma, you should actually show improvements in your overall functioning. In other words, when you say you think you are better (perceived growth), you are in fact better (actual growth). Well, the researchers found that the perception of growth was unrelated to actual growth. Moreover, the perception of growth was linked to more distress at semester’s end.

In short, just because someone perceives they are better off does not mean that they are. In fact, it may very well mean that they are not.

Perceived Growth Is Likely a “Positive Illusion” 

Why would someone perceive that they have grown when they have not? One explanation is that perceiving growth is a way of coping with the event itself. In this framework, post-traumatic growth isn’t growth at all. It’s a “motivated positive illusion” whose purpose is to protect us from the possibility that we may have been damaged. In fact, one unusually rigorous experimental study found that when an event threatens our sense of self, we are more likely to believe that the event made us better in some way.

Alas, this coping strategy is ineffective. People who perceive growth tend to do worse over the short and the long term compared to people who don’t. How do we know? One recent study looked at soldiers returning from a deployment to Iraq. They found that soldiers who reported posttraumatic growth 5 months after returning home saw an increase in PTSD symptoms at 15 months. Another study published this year on survivors of the Oslo bombings, the horrific 2011 massacre in Norway, found the exact same result–early posttraumatic growth = later PTSD.  In short, perceiving growth portends worse functioning, not better.

Are There Benefits to Adversity?

Does this mean we cannot benefit from adversity? Absolutely not. But before we can understand how, we have to understand the difference between perceptions of change and actual change. When we conflate the two, we walk ourselves down the garden path.

However, when we focus on actual change, we find that acute adversity can benefit us. But only for some people and only under some circumstances. Indeed, these benefits may only occur among people who were highly distressed before the trauma occurred. In other words, acute adversity may paradoxically help us to feel better. In my next blog post, I’ll discuss this phenomenon in relation to a recent paper of mine on survivors of the Virginia Tech campus shootings. We’ll see that acute adversity can be–strangely and sometimes–just what the doctor ordered.