Resilience, gratitude and post-traumatic growth
Processing trauma is more complicated than we think
About three years into my career as a chaplain, working with care providers and patients in critical care settings, I noticed that I had a deeper appreciation for the ordinary. Life is fragile, I realized. I had less interest in thrillers, action or suspense, and more for the everyday.
For my 40th birthday, I spent the day doing simple, mundane things like mowing the grass, getting the oil changed on my car, and getting a haircut. For dinner, we had pizza. It was exactly what I wanted. If I was looking for excitement, all I had to do was go to work. That was more than 25 years ago, and I still have little need for a hit of adrenaline. My sense of gratitude for the simple things has held steady over the years.
I learned later that there is a name for my experience: “post-traumatic growth,” or PTG. Struggling with adversity can lead to positive psychological changes, such as a deeper appreciation for life, a sense of new possibilities, closer relationships, a feeling of greater personal strength and a deeper understanding of spirituality . The study of PTG was pioneered in the 1990s and holds that people who endure struggles following adverse events can often see positive growth afterwards [2, 3].
There is some truth to the saying that “what doesn’t kill you makes you stronger,” an aphorism of the 19th century philosopher Friedrich Nietzsche . The saying is generally used as an affirmation of resilience, and recent studies link resilience to gratitude .
In an industry filled with high-stress incidents, where providers face traumatic scenes on a daily basis, we are fortunate to be supported by leaders, resources and mental health providers who understand the emotional weight of the profession. Gratitude and resilience can be effective resources for growing from difficult experiences, linked to post-traumatic growth. “Trauma shatters your worldview and disrupts your core beliefs,” says Amy Canevello, a psychology professor at the University of North Carolina. “And post-traumatic growth, at least theoretically, is the result of you trying to put your worldview back together in a way that incorporates that traumatic event. You come out the other side looking different in some way” . Learning the practice of gratitude can be a powerful offset to the challenges that come from working in emergency medicine.
At the same time, there is some risk to targeting post-traumatic growth in interventions. For instance, “intervention participants might be induced to feel shame or discouragement if they seem to have ‘failed’ at attaining personal growth while struggling to survive an unspeakably painful time in their lives” . “In some cases, this narrative around the potential to grow could be oppressive,” says Eranda Jayawickreme, a professor of psychology at Wake Forest University in North Carolina. “It creates the expectation that not only do I have to recover from what happened to me, but apparently, I'm supposed to become better than ever before.” And this pressure, he thinks, could lead to worse mental health outcomes for some individuals .
This suggests that for some people, the expectation that they will respond with growth and gratitude may be an unhelpful way of processing trauma. In that case, we should be especially wary of encouraging paramedics, EMTs and dispatchers to see positive transformations resulting from their experiences . It could be particularly damaging if the conversation about post-traumatic growth means that we start to expect our coworkers to recover too quickly from a bad call .
In the meantime, it is important to keep in mind that each individual’s experience is going to be very different and must be judged on its own terms. The priority should be providing whatever support they personally need to come to terms with the high-stress calls, whether they are reporting distress or growth – or both at the same time – without imposing a narrative on their recovery .
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- Roepke, Zikopoulos and Forgeard. Post-Traumatic Growth Interventions, in Redesigning Research on Post-Traumatic Growth: Challenges, Pitfalls, and New DirectionsChallenges, Pitfalls, and New Directions | Request PDF (researchgate.net) Infurna, FrankJ. And Eranda Jayawickreme, eds. New York: Oxford University Press, 2021,p. 28
- The Posttraumatic Growth Inventory: measuring the positive legacy of trauma - PubMed (nih.gov)
- Collier L. Growth after trauma. American Psychological Association
- What doesn’t kill you, makes you stronger Meaning & Origin | Slang by Dictionary.com
- The Importance of Gratitude in the Time of COVID (verywellmind.com), Gratitude: The best medicine during tough times (ucdavis.edu)
- The complicated truth of post-traumatic growth - BBC Worklife