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Post-Traumatic Growth, Resilience or Pure Stubbornness?

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Not too long ago The New York Times ran an article proposing a positive side of post-traumatic stress disorder (PTSD).  It featured the US Army Comprehensive Soldier Fitness Program, an ambitious application of positive psychology initiated by BG (Ret) Cornam with guidance from Dr. Martin Seligman. Basically, the idea is to train soldiers and families to see the positive possibilities in a (horrid) situation, to look for opportunity for growth, and to train soldiers to help other soldiers.  The idea of growing from hardship is a bold spin on the disruption caused by PTSD.  Tedeschi and Calhoun defined this as Post-Traumatic Growth in 1996.  Tedeschi looked at application with US Combat Veterans and families in 2011.

Tedeschi defines trauma as an event bad enough to shake your fundamental assumptions of life.  The Army programs have a twist of acknowledging that stress might not be one event, it might be persistent stress.  Chronic pain is like this, daily faced with more ‘event’ and nowhere to go to escape.  When the pain or badness persists it takes more than positive self-talk to keep moving.

There might be a difference between Post-Traumatic Growth and Resilience.  I think it may not matter.  Both emphasize moving forward.  One makes a formal assessment; the other is ‘field expedient’ and practical.  Military families practice resilience daily.  But too much banging against the rough spots can leave you with a rather large headache.  Resiliency Programs are there to teach the skill of knowing when to stop and get help without shame.

Perhaps the most practical messages of the Resiliency Programs are:  “You are not alone” and   “You can make it through this.”   Strong people know when to ask for help.  Compassionate health care provides timely and appropriate resources.  Matching the need and the resource is the challenge in order to have this theory be more than just pretty, positive words.

I can’t talk about Post Traumatic Growth without mentioning the soggy side of resilience and positive psychology.  It’s hard to keep going in persistent stress.    Success can be slippery and hard to measure.  If we can’t measure “it”, can we be sure “it” works?  How does the research translate to the constant stress of military life or chronic pain? Are we looking so hard for something to work that we are falling for reporting and confirmation bias? The Army study is ongoing; it will be interesting to follow.

I recently was lucky to sit with an old friend a “Senior Army Spouse” (she won’t let me quote her) to talk about persistent stress and resilience in real life.  She has been to more funeral services than anyone should count and persists with grace and wisdom.  Our talking started over lunch, continued over cheese/crackers and wine, and finished after beer and crab cakes.  We are resilient and well fed.

About Sandy Hilton

Sandy Hilton PhysiotherapistSandy has no training in the current Resiliency Program but was a participant and instructor in some of its predecessors. She has had 24 years of hanging with Army families and positively coping. Her day job is a clinical PT working with persistent pain and pelvic health.  She is working towards her DPT and has a few ideas about treating pelvic pain from a broad perspective.  Tweeting @SandyHiltonPT

References:

1. Rendon, J. Post-Traumatic Stress‘s Surprisingly Positive Flip Side. New York Times 25 March 2012

2. Comprehensive Soldier Fitness.

3. Tedeschi RG, & Calhoun LG (1996). The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. Journal of traumatic stress, 9 (3), 455-71 PMID: 8827649

4. Tedeschi RG (2011). Posttraumatic growth in combat veterans. Journal of clinical psychology in medical settings, 18 (2), 137-44 PMID: 21626349

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