Rethinking posttraumatic growth: Psychological processes, outcomes, and individual differences between survivors of multiple types of adverse events

Abstract

This thesis examines the claim that people can report positive changes following adverse experiences, in a phenomenon known as posttraumatic growth (PTG). Existing literature has advanced knowledge of factors related to PTG, although the applicability of existing theories to explain PTG in survivors of multiple adverse events is unclear. The extent to which PTG is related to event characteristics and posttraumatic stress is ambiguous. In addition, factors associated with long-term PTG change are poorly understood, and there are concerns that PTG may not always reflect positive improvements in well-being. Adopting a mixed-method approach across four studies, this thesis investigated the psychological processes implicated in PTG development, beginning with the characteristics of the adverse event, followed by attempts to understand the experience, and concluding with longer-term PTG outcomes. Study 1 addressed a gap in the literature by examining the extent to which the type, frequency and timing of adverse events were associated with PTG in 268 survivors of multiple and wide-ranging events. It was found that while the type, frequency and timing of adverse events were unrelated to growth, event characteristics shaped emotional responses to the event which were conducive of PTG. Study 2 explored these individual differences in PTG outcomes using semi-structured interviews with 26 people exposed to cumulative adversity from Study 1. Findings provided insight into the psychological factors that facilitate or inhibit PTG, drawing attention to the social context in which growth can occur and emphasising the key role of cognitive processes. Study 3 drew upon key cognitive themes from Study 2 to develop a model to explain relationships between cognitive processing variables not accounted for in existing PTG frameworks in 250 survivors of multiple types of adverse events to report growth and distress. Finally, Study 4 assessed the factors that influence PTG trajectories over an 18-month period using the 268 participants from studies 1 to 3. Intrusive thoughts were the strongest predictor of the average growth trajectory, regardless of the type, frequency, or experience of subsequent events. Four distinct PTG trajectories were revealed that were influenced by a range of psychosocial variables that promoted positive well-being. Growth reports also appeared to serve as a coping strategy. The unique contributions of this thesis have implications for understanding the nature and process of PTG. First, existing PTG models require further revision and expansion to accommodate individual differences. Second, event characteristics can indirectly influence growth through coping, cognitive and social factors that allow people to succumb or thrive after cumulative adverse events. Third, growth is accompanied by distress and vice-versa. Fourth, growth may reflect a coping strategy to minimise distress and thus not reflect actual change, yet also co-exist alongside enhanced psychological functioning in other cases. Finally, PTG is not always consistent or stable over time as previously thought, and can serve different psychological functions. More mixed-method and longitudinal investigations are needed to advance the study of PTG so that firm recommendations can be made to inform clinical practice.