1. Constitutional factors : These are the inherent personality structure and the psychobiological and genetic aspects that contribute to hardiness and resilience or make the person more vulnerable to stress. Is the person an introvert or extrovert? Does the individual have a genetic predisposition for stress reactivity? Is the individual easy-going or rigid in style? 2. Preexisting conditions: Does the person have any illnesses or physical, emotional, or learning disabilities? Did the person have a healthy or dysfunctional family background prior to the occurrence of the traumatic event? Does the person have a history of any previous trauma in their life? 3. Chronology : What happened when? How old was the individual when the trauma first occurred and when it ended? What was the sequence of events? (For example, the effect of losing one’s mother is different for Teresa, a 12-year-old pubescent girl than for Thomas, a 3-year-old boy.) 4. Nature of the traumatic contact: What actually happened? Was the trauma an act of God or at the hands of a person? How fearful did the survivor feel before, during, and after the event? Was the event painful or, as in some cases of nonforced sexual abuse, did it generate unwanted pleasant feelings? Was the individual alone when it happened? Were there any witnesses to the event? 5. Cumulative trauma: Was the trauma a one-time occurrence or was it repeated over time? Were there multiple forms of trauma, abuse, or neglect? (For example, Teresa and Thomas experienced multiple forms of trauma, abuse, and neglect.) Was there a single perpetrator or many? Were the events acts of God or nature, acts caused by other people, or both? 6. Coping resources: What human, emotional, physical, spiritual, internal, and external resources were available to help the survivor during and following the trauma? Were any family members, friends, community members, or professionals available to help? Was there a church, synagogue, mosque, or teacher or spiritual leader involved as a resource person or a source of comfort? Were medical professionals, good friends, neighbors, or pets available as resources? Was the survivor able to access internal resilience through deep faith or intellectual capabilities or connections with others? 7. Perceived control: Did the survivor feel that they had control during the trauma? Was the individual able to extricate themselves from the trauma under their own power? To any extent? With help from others? Did the survivor expect to have been able to get out or away or realize that they had no choice and no options at the time? Posttraumatic Growth The term posttraumatic growth (PTG) was coined by Tadeschi and Calhoun in the mid-1990s, and they have maintained the same definition since that time. They define PTG as “positive psychological changes experienced as a result of the struggle with traumatic or highly challenging life circumstances” (Tedeschi et al., 2018). This growth may include an “increased sense of personal strength, a deeper appreciation for life,” improved interpersonal relationships, and a richer spiritual identity (Roepke, 2015, p. 129). Though resilience and PTG may sound similar, PTG is a distinct phenomenon (Kilmer et al., 2014). Transformative growth is unique to PTG. Moreover, PTG is not necessarily associated with positive adjustment in the same way as resilience, and individuals maintaining PTG may also exhibit posttraumatic stress symptoms (Kilmer et al., 2014). In fact, while adaptive and active coping styles seem to help facilitate growth, they are not always found to be associated with decreased PTSD symptoms (Peters et al., 2021). Thus, many people who experience PTG do so as they “come to grips with their new reality” and attempt to make meaning of life after the trauma (Kilmer et al., 2014, p. 507). As PTG varies individually and culturally, it is difficult to find a consensus as to what constitutes said growth (Tedeschi et al., 2018). However, the concept of PTG has been validated on a global scale (Taku et al., 2021), and
8. Cognitions: How does the survivor understand what happened and why? Does the survivor blame themselves? Blame others? Blame God? Whom does the survivor hold responsible for the events? What meaning did the survivor make out of what happened? Does the survivor perceive that they were in the wrong place at the wrong time? 9. Degree of moral conflict: Did the trauma survivor have to participate actively in any aspect of the traumatic events? Was the survivor forced to make choices or take actions that they saw as morally reprehensible? Was the survivor forced to harm, injure, or degrade someone else as part of their abuse? (For example, was the survivor given orders during combat to fire on a village that they believed contained children or civilians? Or, as in the case of William Styron’s [1979] novel Sophie’s Choice, was the survivor forced to sacrifice one child to save another?) 10. Conditioning: Was the survivor acclimated over a period of time to accept, participate in, or stop resisting the traumatic acts? Did a grooming period take place, during which the offender slowly and gradually gained the person’s trust with increasingly intrusive acts? Was behavioral conditioning used, as in the situation of prisoners of war who are systematically deprived of food, sleep, or human contact? Was the survivor raised in a family system in which neglectful or abusive acts seemed normal because that was all they knew? 11. Communication: Was the survivor able to make their distress known to others? Were they old enough to talk? How did others receive the communication of distress? Did they believe the person or not? Was help forthcoming? Was the survivor silenced by direct or indirect threats of dire consequences to themselves or to others if they broke the silence? Could the survivor get word to anyone about the situation? Was the survivor literate or illiterate? Did the survivor speak the same language as the offender? 12. Cultural context: What are the norms for the culture in which the survivor grew up? What was usual or unusual? What did class, religion, ethnicity, race, or gender mitigate? How are these norms understood and accepted today by the survivor and by the clinician? (For example, faith healing is the norm for some cultures, whereas in other cultures it constitutes medical neglect. How does the client perceive it? Even if it is perceived as part of familial dysfunction, will it also be a function of the survivor’s cultural upbringing?) Note: Adapted from personal lecture notes from Hypnotherapy for the Treatment of Trauma, 1996, by D. Brown . one meta-analysis found that nearly half of individuals exposed to trauma reported moderate to high levels of PTG (Wu et al., 2019). Several domains of growth and numerous factors correlated with PTG outcomes exist. PTG can manifest as “increased spirituality, sense of understanding, belongingness, personal strength, appreciation of one’s life, and quality of relationships” (Prati & Pietrantoni, 2009, p. 364). For some, the continued distress and efforts to reconcile suffering result in a cognitive process—productive rumination—whereby the continuous processing of the trauma generates new growth (Kilmer et al., 2014). Psychosocial variables such as dispositional optimism, reappraisal and acceptance coping strategies, self-efficacy, and an internal locus of control are all associated with PTG (Prati & Pietrantoni, 2009). Additionally, social support and cultural beliefs can also facilitate PTG (Vázquez et al., 2014). However, these predictors appear to be somewhat culture-dependent (Taku et al., 2021). Newer studies have also acknowledged a domain termed “posttraumatic depreciation” (PTD) that can coexist alongside PTG, representing the “negative side of growth” (e.g., learning how cruel people can be) (Taku et al., 2021).
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Book Code: PYFL4024
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