This article describes the concept of posttraumatic growth, its conceptual foundations, and supporting empirical evidence. Posttraumatic growth is the experience of positive change that occurs as a result of the struggle with highly challenging life crises. It is manifested in a variety of ways, including an increased appreciation for life in general, more meaningful interpersonal relationships, an increased sense of personal strength, changed priorities, and a richer existential and spiritual life. Although the term is new, the idea that great good can come from great suffering is ancient. We propose a model for understanding the process of post-traumatic growth in which individual characteristics, support and disclosure, and more centrally, significant cognitive processing involving cognitive structures threatened or nullified by the traumatic events, play an important role. It is also suggested that posttraumatic growth mutually interacts with life wisdom and the development of the life narrative, and that it is an ongoing process, not a static outcome.
In his memoir, No Such Thing as a Bad Day, Hamilton Jordan (2000) described some of the changes he experienced following his battle with cancer:
After my first cancer, even the smallest joys in life took on a special meaning - watching a beautiful sunset, a hug from my child, a laugh with Dorothy. That feeling has not diminished with time. After my second and third cancers, the simple joys of life are everywhere and are boundless, as I cherish my family and friends and contemplate the rest of my life, a life I certainly do not take for granted. (p. 216)
Geology professor Sally Walker is a survivor of an airline crash that killed 83 people: "When I got home, the sky was brighter, I paid attention to the texture of sidewalks. I was like being in a movie. ... [Now] Everything is a gift" (Shearer, 2001, p. 64). International cycling champion Lance Armstrong was diagnosed with testicular cancer in 1996. The cancer had spread to his brain and his lungs. He had to undergo multiple surgeries and grueling chemotheraphy. Armstrong had this to say about his battle with cancer:
Looking back, I wouldn't change anything. Had I not been sick, I wouldn't have met my wife. I don't feel unlucky to have had to go through this. I learned a lot and grew tremendously the last two years. (Becker, 1998, p. 3C)
As these brief accounts suggest, the frightening and confusing aftermath of trauma, where fundamental assumptions are severely challenged, can be fertile ground for unexpected outcomes that can be observed in survivors: posttraumatic growth. The term posttraumatic growth refers to positive psychological change experienced as a result of the struggle with highly challenging life circumstances (Calhoun & Tedeschi, 1999, 2001). We use the words trauma, crisis, highly stressful events, and other similar terms interchangeably, as roughly synonymous expressions. Our usage of these terms is a bit broader and less restrictive than their usage in some literatures (e.g., American Psychiatric Association, 2000). With these expressions we are describing sets of circumstances that represent significant challenges to the adaptive resources of the individual, and that represent significant challenges to individuals' ways of understanding the world and their place in it (Janoff-Bulman, 1992). In what follows we provide a brief description of some of the negative psychological consequences that can be triggered by highly stressful events, a general description of the ways in which posttraumatic growth is experienced, and how the concept of posttraumatic growth differs from other similar constructs. Next, we provide an extensive description of a framework for understanding the process of posttraumatic growth with an emphasis on the role of cognitive processing. Finally, we make some general conclusions and suggest some possible extensions of the concept for future work.
Typical Negative Reactions to Highly Stressful Events
Although the main focus here is on the possibilities of positive change arising from the challenge of difficult circumstances, it is appropriate to begin with the reminder that difficult circumstances can produce psychological distress, and to briefly review the kinds of negative responses that are quite common in persons exposed to highly stressful events. In doing so, we want the reader to understand that we recognize that traumatic events are not to be viewed simply as precursors to growth. They are profoundly disturbing. Second, it is important to recognize that the psychological processes involved in managing the disturbances are the same general types of processes that also can produce positive changes.
People facing major life crises typically experience distressing emotions. Particularly for sets of circumstances that threaten the person's physical well-being, anxiety or specific fears are common. Depending on the intensity, severity, and duration of physical threat or suffering (either direct or vicarious), the anxious responses can persist for a long time after the actual threat is removed. Sadness and depression can be common responses to life crises. Reactions to the loss of a loved one, for example, typically include sadness, yearning for the deceased, and a general wish that things could be different. As data indicate, of course, these responses are typical but not universal (Wortman & Silver, 2001). Guilt, anger, and general irritability are other affective responses commonly observed in persons struggling with significant life problems.
Distressing and sometimes dysfunctional patterns of thinking can be set in motion by major life crises. For sudden and unexpected events, initial reactions of disbelief and the experience of psychological numbness are common. For highly threatening events, repetitive intrusions of thoughts and images of the challenging event are common. Intrusive ruminative thought may be more common than intrusive images, but both tend to be experienced as unpleasant and distressing.
When the level of stress is high, a variety of unpleasant physical reactions can be experienced as well. Specific responses vary across individuals, but they can include prolonged activation of bodily systems that can be experienced in the form of fatigue, muscle tension and aches, gastric symptoms, and general physical discomfort. Finally, although in most sets of circumstances individuals facing even the most traumatic sets of circumstances do not develop psychiatric disorders, exposure to major life crises does indeed increase the risk of developing psychiatric problems (Rubonis & Bickman, 1991).
As we turn our attention to the main focus of this target article, posttraumatic growth, it is important to maintain the perspective that major life crises typically engender unpleasant psychological reactions. Posttraumatic growth occurs concomitantly with the attempts to adapt to highly negative sets of circumstances that can engender high levels of psychological distress. For a minority of persons who experience them, major life crises can serve as the catalysts for the development or exacerbation of significant psychiatric difficulties. The main focus of work in psychology, medicine, and related disciplines, has traditionally been on the ways in which traumatic events are precursors to highly distressing and sometimes severe sets of psychological and physical problems. Because the predominant scholarly and clinical work has been done with persons facing very difficult circumstances, and because the focus was on persons who had entered the therapeutic system because of the presence of noticeable psychological difficulties, this "negative" focus is understandable, and appropriate to the requirements of those contexts.
In the developing literature on posttraumatic growth, we have been finding that reports of growth experiences in the aftermath of traumatic events far outnumber reports of psychiatric disorders. This is despite the fact that we are concerned with truly traumatic circumstances rather than everyday stressors. The widespread assumptions that traumas often result in disorder should not be replaced with expectations that growth is an inevitable result. Instead, we are finding that continuing personal distress and growth often coexist. Although not prevalent in either clinical or research settings, there has been a very long tradition of viewing human suffering as offering the possibility of the origin of significant good.
Focusing on the positive aspects of the struggle with trauma
The general understanding that suffering and distress can be possible sources of positive change is thousands of years old. For example, some of the early ideas and writings of the ancient Hebrews, Greeks, and early Christians, as well as some of the teachings of Hinduism, Buddhism, and Islam contain elements of the potentially transformative power of suffering (Tedeschi & Calhoun, 1995). A major theme of Christian traditions, for example, are the narratives about the transformative effect of the execution of Jesus.
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In the 20th century several clinicians and scientists (e.g., Caplan, 1964; Dohrenwend, 1978; Frankl, 1963; Maslow, 1954; Yalom, 1980, writing in the general domain of psychology, addressed the ways in which critical life crises offered possibilities for positive personal change. Maslow (1970), for example, whose most influential work was originally published in the 1950s and 1960s, argued consistently that psychologists should expend much greater efforts in studying "people who are actually healthy," (p.270) and the better and brighter aspects of human behavior and nature. Caplan, a pioneer in what earlier was called community psychiatry, wrote extensively about the processes whereby individuals encountering major life crises might be helped to cope effectively and, as a consequence, to develop psychologically as a result of what they had experienced. More recent calls for an emphasis on positive psychology (Cowen & Kilmer, 2002; Seligman & Csikszentmihalyi, 2000) represent a continuation of this useful tradition.
It was not until the 1980s, and then more strongly in the 1990s, however, that systematic scholarly interest specifically focused on the possibility of growth from the struggle with trauma emerged. This area of inquiry is important for some very simple reasons. The evidence is overwhelming that individuals facing a wide variety of very difficult circumstances experience significant changes in their lives that they view as highly positive. Although much progress has been made recently, little is known about the processes, concomitants, and consequences of the experience of growth. Investigations in this area can inform us about psychological phenomena about which we know very little, and as they do so, they can provide significant information for those who attempt to provide assistance to those coping with major life disruptions.
Types of Trauma and Posttraumatic Growth
There are now reports in the literature of a very wide array of major life challenges that have acted as catalysts for posttraumatic growth. (...)
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