Trauma and Its Aftermath: Post Traumatic Growth and PTSD

Psychologist John Leach, a specialist in human responses to emergency situations, developed his “10/80/10 rule of survival” after examining a variety of crises and human reactions to them. According to Leach, 10 percent of people facing an emergency control their fears and act rationally. Eighty percent find themselves stunned and relatively unprepared to respond. The last 10 percent, Leach concluded, become hysterical, unable to cope with the situation at hand. To ensure you land in that top 10 percent, you should first understand the physiological processes your brain and body undergo during an emergency.

The sympathetic nervous system, which stimulates the fight-flight-or-freeze response, takes control of the body. As a result, three key hormones are released into the bloodstream: adrenaline, norepinephrine, and cortisol. Adrenaline and norepinephrine prepare the body for battle. You receive a high-octane energy boost from increased glucose production and release. But this increase in glucose production burns valuable resources in the body. Your heart rate increases, and the lungs expand to take in more oxygen (a process known as bronchial dilation). Pupils dilate, narrowing your vision. Blood is channelled away from the digestive system and the skin toward the major skeletal muscles for quick action and strength. Cortisol is released more slowly than adrenaline and norepinephrine, and it helps sustain the fight-or-flight response over an extended period. The digestive and immune responses are slowed in anticipation of a fight. Over time, the engaged sympathetic nervous system depletes the body's energy reserves of glycogen and fat stores. If it goes on too long, you could experience a crash that leaves you feeling cold and tired. The more primitive portion of the brain, the limbic system, takes control from the more developed frontal lobe. Thoughts become less logical and more visceral. This can lead to impulsive and irrational behaviour. Over time, when panic subsides, frontal lobe activity increases and rational thought returns. This is how your body responds in all emergency situations and if you know how to respond it may save your life, prevent trauma or at least decrease the chances of getting traumatised.

What goes on inside the brains of people with PTSD? PTSD is painful and frightening. The memories of the event linger, and victims often have vivid flashbacks. Frightened and traumatized, they are almost always on edge and the slightest of cues sends them hurtling back inside their protective shells. Usually victims try to avoid people, objects, and situations that remind them of their hurtful experiences; this behaviour prevents them from living their lives meaningfully. Many victims forget the details of the incident, obviously to lessen the blow. But this coping mechanism has negative repercussions as well. Without accepting and reconciling with “reality,” they turn into fragmented souls.

Extensive neuroimaging studies on the brains of PTSD patients show that several regions differ structurally and functionally from those of healthy individuals. The amygdala, the hippocampus, and the ventromedial prefrontal cortex play a role in triggering the typical symptoms of PTSD. These regions collectively impact the stress response mechanism in humans, so the PTSD victim, even long after his experiences, continues to perceive and respond to stress differently than someone who is not suffering the aftermaths of trauma.

The most significant neurological impact of trauma is seen in the hippocampus, which is responsible for memory functions. PTSD patients with reduced hippocampal volumes lose the ability to discriminate between past and present experiences or interpret environmental contexts correctly. Their neural mechanisms trigger extreme stress responses when confronted with environmental situations that only remotely resemble something from their traumatic past.

Severe emotional trauma causes lasting changes in the ventromedial prefrontal cortex region of the brain that is responsible for regulating emotional responses triggered by the amygdala. Specifically, this region regulates negative emotions like fear that occur when confronted with specific stimuli. PTSD patients show a marked decrease in the volume of ventromedial prefrontal cortex and the functional ability of this region. This explains why people suffering from PTSD tend to exhibit fear, anxiety, and extreme stress responses even when faced with stimuli not connected – or only remotely connected – to their experiences from the past.

Trauma appears to increase activity in the amygdala. This region of the brain helps us process emotions and is also linked to fear responses. PTSD patients exhibit hyperactivity in the amygdala in response to stimuli that are somehow connected to their traumatic experiences. They exhibit anxiety, panic, and extreme stress when they are shown photographs or presented with narratives of trauma victims whose experiences match theirs; or made to listen to sounds or words related to their traumatic encounters. What is interesting is that the amygdala in PTSD patients may be so hyperactive that these people exhibit fear and stress responses even when they are confronted with stimuli not associated with their trauma, such as when they are simply shown photographs of people exhibiting fear.

Researchers believe that the brain changes caused by PTSD increase the likelihood of a person developing other psychotic and mood disorders. But amid such grim findings, scientists also sound a note of hope for PTSD patients. They have also realized that the disorder is reversible. The human brain can be re-wired. The brain is a finely tuned instrument. It is fragile, but it is heartening to know that the brain also has an amazing capacity to regenerate.

Aharon Margalit is an example of one who had much suffering and jubilation during his life. After a traumatic event in early childhood, he acquired a severe speech disorder. Shortly afterward he was stricken with polio. Paralyzed and unable to communicate, he was confined for several years in a sanitorium. After he eventually recovered and overcame his speech disorder, he built up a successful business. At the height of his success, he was diagnosed with a malignant tumour. He refused to give in to the predictions and decided that as long as he lived, he would fight. He fought – and he lived. Each time the cancer returned, he triumphed. Now he goes around giving lectures and inspiring others not to give up. He teaches others how to live life to the fullest. Through the trauma that he went through he helps others.

As Kay Wilson struggled to make her way through a Jerusalem forest after being repeatedly stabbed by a Palestinian terrorist, she distracted herself from her agony by playing a song in her mind, composing a new piano arrangement while she fought for breath and forced herself to put one bare foot in front of the other. Wilson, then 46, had been working as a tour guide when, on Dec. 18, 2010, she and a friend were ambushed by terrorists. Wilson witnessed her friend's murder and was herself viciously stabbed with a machete, ultimately playing dead as her attacker plunged his knife into her chest a final time. She eventually recovered from her severe physical wounds and is healing from her psychological trauma. She now speaks to global audiences about her survival. After the attack, Wilson had flashbacks and deep survivor's guilt. But like many people who have survived trauma, she has found positive change as well—a new appreciation for life, a newfound sense of personal strength and a new focus on helping others.

Tzipi Canton was diagnosed with cancer in eleventh grade. She writes “Any life experience will help mould a person and cancer has definitely done that to me.” There is always light at the end of the tunnel and you need to go through the tunnel – event – in-order to get the light at the end. She ends off her book with the line “Life is never the same it only becomes more special.” In her opinion, she only thrived because of what she went through and it helped her become the person who she is today.

Every day, people face divorce, death, bankruptcy, job losses and other traumatic experiences. Some recover quickly and resume fulfilling lives, while others get caught up in their misfortunes – often spiralling into emotional despair and mental illness. Why? What makes some people more resilient than others? How is it that some individuals overcome and thrive despite the most trying circumstances, while others struggle at the first sign of trouble?

Many studies show that previous emotional health is a good indicator of future resiliency. Other research shows that environmental factors and genetic differences play a role in determining individual responses to stress. While researchers continue to try to understand why some people can bounce back better than others, certain character traits among the most resilient seem evident.

Post-traumatic growth (PTG) is a theory that explains this kind of transformation following trauma. It was developed by psychologists Richard Tedeschi, PhD, and Lawrence Calhoun, PhD, in the mid-1990s, and holds that people who endure psychological struggle following adversity can often see positive growth afterward. They develop new understandings of themselves, the world they live in and how to relate to other people. It also effects the kind of future they might have and a better understanding of how to live life.

PTG can be confused with resilience, but the two are different constructs. Resiliency is the personal attribute or ability to bounce back. PTG, on the other hand, refers to what can happen when someone who has difficulty bouncing back experiences a traumatic event that challenges his or her core beliefs, endures psychological struggle (even a mental illness such as post-traumatic stress disorder), and then ultimately finds a sense of personal growth. It's a process that takes a lot of time, energy and struggle. Someone who is already resilient when trauma occurs won't experience PTG because a resilient person isn't rocked to the core by an event and doesn't have to seek a new belief system. Less resilient people, on the other hand, may go through distress and confusion as they try to understand why this terrible thing happened to them and what it means for their world view.

The number of people who experience PTG depends on many things including the trauma and circumstances. However, it is estimated that about one-half to two-thirds of people show PTG. PTG is generally stable over time, with a few people showing increases and a few showing decreases. There appear to be two traits that make some more likely to experience PTG, says Tedeschi: openness to experience and extraversion. That's because people who are more open are more likely to reconsider their belief systems, and extroverts are more likely to be more active in response to trauma and seek out connections with others. Women also tend to report more growth than men, says Tedeschi, but the difference is relatively small. Age also can be a factor, with children under 8 less likely to have the cognitive capacity to experience PTG, while those in late adolescence and early adulthood—who may already be trying to determine their world view—are more open to the type of change that such growth reflects. Is it possible to prepare people for PTG, to pave the way should tragedy or trauma strike? Yes, one can allow people to understand that this may be a possibility for themselves and is a normal process, when trauma occurs.

Hayward, who works with veterans at VA Long Beach Medical Centre in Long Beach, California, knows about such growth first-hand: She was paralyzed in a car accident when she was 16, ending a competitive athletic career. She overcame that trauma through the help of supportive family and friends, went on to study social psychology at Harvard and has travelled to more than 42 countries, often on humanitarian missions providing counselling and other support to trauma victims. Today, she credits the accident for increasing her strength of character 'exponentially' by forcing her to overcome challenges. She also appreciates life and relationships with others—including the near-daily support in the small tasks of daily living that she gets from friends and strangers alike: 'those interactions warm my heart.'

Social support can influence experiencing stress in three ways. First, it can directly reduce the level of occupational stress. Secondly, social support can enhance wellbeing, which means that the person experiencing a high level of support feels safer and more comfortable. Thirdly, social support can constitute a buffer protecting the individual against the occurrence of negative outcomes of the experienced trauma or reducing their severity. Social support is regarded as a protective shield for one to be protected against health deterioration. In other words, social support can directly influence stress and wellbeing, as well as moderate the correlation between stress and its outcomes. In the process of effective coping with trauma, which may lead to the occurrence of positive changes, both received and perceived support is important. The type of support and its source are also important. In the initial stages of coping with trauma, emotional support is more important, while in the subsequent stages the importance of instrumental support increases.

Change is something that presses us out of our comfort zone. It is destiny-filtered, heart grown, faith built. It is inequitable; not a respecter of persons. It can be for the better or for the worse depending on how you view it. Change has an adjustment period which varies on the individual and it has a ripping effect on those who won’t let go. Flexibility is the key. Even a roller coaster ride can be fun if you know when to lean and create new balance within the change. Change is won by victors not victims; and that choice is ours. It pushes you to do your personal best. Change seeks a better place at the end and is complete when you realize you are different. It is only a waste for those who don’t learn from it. Change happens in the heart before it is proclaimed by our works. It can flow or jerk, depending on our resistance to it. Change is like driving in a fog – you can’t see very far, but you can make the whole trip that way. Change is here to stay.

Some changes involve additions, while others involve losses. Some changes are sudden, others are more gradual. Change can be good or bad. It depends on the person and the situation. A promotion is good, right? But if you’re unsure of your skills, you may view it as negative. Change may be sought out or it may be forced upon you. It can challenge or stimulate you, or make you feel anxious and threatened. Change is stressful, even when it’s positive. But no change at all can be boring. Strive for balance. Too much stress all at once can be unhealthy. Same, too, if it goes on over a long period of time. People who experience a lot of changes in a brief time period are more likely to have an accident or illness.