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Lawrence Erlbaum Associates. Inc.
Psychological Inquiry
2004. Vol. 15. No.1. 1-18
TARGET ARTICLE
Posttraumatic Growth: Conceptual Foundations and Empirical Evidence
Richard G. Tedeschi and Lawrence G. Calhoun
University of North Carolina Charlotte
This article describes the concept of posttraumatic growth. its conceptual founda-
tions, a/id supporting empirical evidence. Posttraumatic growth is the experience of
positive change that occurs as a result of the struggle with highly challenging life cri-
ses. It is manifested in a variety ofways, including an increased appreciationfor life in
general, more meaningful interpersonal relationships, an increased sense ofpersonal
strength. cha/lged priorities, and a richer existential and spiritual life. Although the
term is ne..", the idea that great good can come from great suffering is ancient. We pro-
pose a nlOdelfor understanding the process ofposttraumatic growth in which individ-
ual characteristics, support and disclosure, a/Id 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 wisdoma,1d the development of the life narrative, and that it is an on-
going process, not a static outcome.
In his memoir, No Such Thing as a Bad Day, Hamil-
ton Jordan (2000) described some of the changes he
experienced following his battle with cancer:
As these brief accounts suggest, the frightening and
confusing aftermath of trauma, where fundamental as-
sumptions 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, cri-
sis. highly stressful events. and other similar terms in-
terchangeably,as roughly synonymous expressions.
Our usage of these terms is a bit broader and less re-
strictive 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 re-
sources 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 negati ve psychological consequences that can be
triggered by highly stressful events, a general descrip-
tion of the ways in which posttraumatic growth is ex-
perienced, 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.
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 air-
line crash that killed 83 people: ..When I got home, the
sky was brighter, I paid attention to the texture of side-
walks. It was like being in a movie. ...[Now] Every-
thing is a gift" (Shearer, 200J , p. 64). International cy-
cling 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 surger-
ies and grueling chemotherapy. Armstrong had this to
say about his battle with cancer:
Looking back, I wouldn't change anything. Had I not
been sick,1 wouldn't have met my wife.1 don't feel un-
lucky to have had to go through this. I learned a lot and
grew tremendously the last two years.(Becker, 1998,
p.3C)
TEDESCHI & CALHOUN
Finally, we make some general conclusions and sug-
gest some possible extensions of the concept for future
work.
Typical Negative Reactions to Highly
Stressful Events
disorders, exposure to major life crises does indeed in-
crease 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 circum-
stances 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 precur-
sors to highly distressing and sometimes severe sets of
psychological and physical problems. Because the pre-
dominant 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 notice-
able 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 de-
spite the fact that we are concerned with truly trau-
matic 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 find-
ing that continuing personal distress and growth often
coexist. Although not prevalent in either clinical or re-
search settings, there has been a very long tradition of
viewing human suffering as offering the possibility for
the origin of significant good.
Focusing on the Positive Aspects or the
Struggle With Trauma
The general understanding that suffering and dis-
tress 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 ofChris-
tian traditions. for example. are the narratives about the
transformative effect of the execution of Jesus. His suf-
fering is viewed as having the power to transform oth-
ers. In some Isiamic traditions. suffering is seen as
instrumental to the purposes of Allah (Bowker. 1970).
Although the main focus here is on the possibilities
of positive change arising from the challenge of difti-
cult circumstances, it is appropriate to begin with the
reminder that difficult circumstances can produce PSY-
chological 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 precur-
sors to growth. They are profoundly disturbing. Sec-
ond, it is important to recognize that the psychological
processes involved in managing the disturbances are
the same general types of processes that also can pro-
duce positive changes.
People facing major life crises typically experience
distressing emotions. Particularly for sets of circum-
stances 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 re-
sponses can persist for along time after the actual
threat is removed. Sadness and depression can be com-
mon 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 ru-
minative thought may be more common than intru-
sive images, but both tend to be experienced as un-
pleasant and distressing.
When the level of stress is high, a variety of un-
pleasant 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 trau-
matic sets of circumstances do not develop psychiatric
2
r
POSTfRAUMATIC GROwrH
Miles & Crandall. 1983; Nerken. 1993; Schwab.
1990). rheumatoid arthritis (Tennen. Affleck. Urrows.
Higgins. & Mendola. 1992). my infection (Bower.
Kemeny. Taylor. & Fahey. 1998; Schwartzberg.
1993). cancer (Collins. Taylor. & Skokan. 1990;
Cordova, Cunningham. Carlson. & Andrykowski.
2001 ), bone marrow transplantation (Andrykowski,
Brady, & Hunt, 1993; Curbow, Somerfield, Baker,
Wingard, & Legro, 1993), heart attacks (Affleck,
Tennen, Croog, & Levine. J 987; Laerum, Johnsen,
Smith, & Larsen, 1987), coping with the medical prob-
lems of children (Abbott & Meredith. J 986; Affleck.
Tennen. & Gershman. 1985). transportation accidents
(Joseph. Williams. & Yule. 1993). house fires
(Thompson, 1985). sexual assault and sexual abuse
(Burt & Katz. 1987; Draucker, 1992; Frazier, Conlon,
& Glaser, 2001; McMilJen. Zuravin. & Rideout. 1995;
Silver. Boon. & Stones. 1983; Yeronen & Kilpatrick.
1983). combat (Elder & Clipp, 1989; Sledge.
Boydstun. & Rabe. 1980). refugee experiences (Berger
& Weiss, in press). and being taken hostage (Cole,
1992; Sank. 1979). It appears that the phenomenon of
posttraumatic growth occurs in a wide range of people.
facing a wide variety of traumatic circumstances.
A central theme of much philosophical inquiry, and the
work of novelists, dramatists, and poets, has included
attempts to understand and discover the meaning of
human suffering (Tedeschi & Calhoun, 1995).
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 per-
sonal change. Maslow ( 1970), for example, whose
most influential work was originally published in the
19505 and 19605, argued consistently that psycholo-
gists should expend much greater efforts in studying
"people who are actually healthy," (p. 270) and the
better and brighter aspects of human behavior and na-
ture. Caplan, a pioneer in what earlier was called com-
munity psychiatry, wrote extensively about the
processes whereby individuals encounteri ng 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 19805, 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 evi-
dence is overwhelming that individuals facing a wide
variety of very difficult circumstances experience sig-
nificant changes in their lives that they view as highly
positive. Although much progress has been made re-
cently, 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 in-
formation for those who attempt to provide assistance
to those coping with major life disruptions.
Posttraumatic Growth Terminology
and Related Concep~
We first used the term posttraumatic growth in print
in an article describing the development of an inven-
tory designed to measure such growth (Tedeschi &
Calhoun, 1996). Earlier in our work we used terms
such as perceived benefits, positive aspects, and the
transformation of trauma (e.g., Calhoun & Tedeschi,
1989-1990, 1991; Tedeschi & Calhoun, 1988, 1995;
Tedeschi, Calhoun, Morrel\, & Johnson, 1984). Many
other terms have been used to describe posttraumatic
growth. These include stren conversion (Finkel, 1974,
1975), positive psychological changes (Yalom &
Lieberman, 1991 ), perceived benefits or construing
benefits (Calhoun & Tedeschi, ]991; McMil\en et al.,
1995; Tennen et a]., 1992), stress-relatedgrowth (Park
et al., 1996),.flourishing (Ryff & Singer, 1998), posi-
tive by-products (McMillen, Howard. Nower, &
Chung, 200 I ), discovery of meaning (Bower et al.,
1998), positive emotions (Folkman & Moskowitz,
2000), and thriving (O'Leary & Ickovics, 1995). Tay-
lor and Brown ( 1988) labeled some similar outcom~s
as positive illusions. Among those emphasizing these
positive changes as coping mechanisms, several terms
have been applied, including positive reinterpretatioll
(Scheier, Weintraub, & Carver, 1986), drawillg
strength from adversity (McCrae, 1984), and
transfornlational coping (Aldwin, 1994; Pargament,
1996).
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. Many of the earlier
research reports mentioned these growth outcomes in
passing, but more recent investigations have been
more specifically focused on these outcomes. Among
the life crises that have produced reports of
posttraumatic growth, at least in some form, are col-
lege students experiencing negative events (Park, Co-
hen, & Murch, 1996), bereavement (Calhoun &
Tedeschi, 1989-1990; Edmonds & Hooker, 1992; Ho-
gan, Morse, & Tason, 1996; Lehman et al., 1993;
3
TEDESCHI & CALHOUN
We favor the term posttraumatic growth because it
appears to capture the essentials of this phenomenon
better than others in several ways. First, in contrast to
what might be suggested by the term stress-related
growth, for example, it appears to focus more dis-
tinctly on the conditions of major crises rather tttan
lower level stress. We discuss later how important sig-
niticant life disruption is to producing the changes we
describe. Second, in contrast to the terms that empha-
size the "illusions" of people who report these changes,
there do appear to be veridical transformative life
changes that go beyond illusion. Third, in contrast to
those terms that emphasize this process as one of many
ways to cope with trauma, for those who are reporting
these changes, they are experienced as an outcome or
an ongoing process, rather than a coping mechanism.
Finally, significant posttraumatic growth may require
a significant threat or the shattering of fundamental
schemas and may at times coexist with significant psy-
chological distress, somelhing the words thriving or
flourishing do not connote. To some extent, these are
semantic choices. It is clear that in spite of wide varia-
lion in such choices, the last 15 years have seen consid-
erable interest in the reports of growth resulting from
the struggle with major life crises.
Posttraumatic growth describes the experience of
individuals whose development, at least in some areas,
has surpassed what was present before the struggle
with crises occurred. The individual has not only sur-
vived, bul has experienced changes that are viewed as
important, and lhat go beyond what was the previous
status quo. Posttraumatic growth is not simply a relurn
to baseline-it is an experience of improvement that
for some persons is deeply profound.
Related Concepts
Distinctions should also be made between
posttraumatic growth and the concepts of resilience,
hardiness, optimism, and sense of coherence. All these
concepts describe certain personal characteristics that
allow people to manage adversity well. Resilience is
usually considered to be an ability to go on with life af-
ter hardship and adversity, or to continue living a pur-
posefullife after experiencing hardship and adversity.
It has often been studied in children who manage to re-
main psychologically healthy despite very difficult cir-
cumstances (Garmezy, 1985; Rutter, 1987; Werner,
1989). Hardiness (Kobasa, 1979; Kobasa, Maddi,
Puccetti, & Zola, 1985) consists of tendencies toward
commitment, control, and challenge in response to life
events. Persons high in hardiness are curious and ac-
tive, believe they can influence events, and expect life
to present challenges that can be met with personal de-
velopment. Optimism involves expectations of posi-
tive outcomes to events (Scheier & Carver, 1985).
Sense of coherence (Antonovsky, 1987) describes per-
sons who are in the best position to manage stress. be-
cause they can comprehend or understand events. can
manage or cope with them. and find meaning in them.
In contrast, posttraumatic growth refers to a change
in people that goes beyond an ability to resist and not
be damaged by highly stressful circumstances; it in-
volves a movement beyond pretrauma levels of adap-
tation. Posttraumatic growth, then. has a quality of
transformation. or a qualitative change in functioning.
unlike the apparently similar concepts of resilience,
sense of coherence. optimism. and hardiness (Tedeschi
& Calhoun, 1995). Although we are not aware of any
direct tests of the relations of hardiness. sense of coher-
ence, and posttraumatic growth. it may be that persons
who are highest on these dimensions of coping capac-
ity will report relatively little growth. That is because
these people have coping capacities that will allow
them to be less challenged by trauma, and we posit that
the struggle with the trauma is what is crucial for
posttraumatic growth. We have previously suggested
the possibility of a general curvilinear relation between
psychological fitness and growth that is analogous to
the relation between levels of physical fitness and re-
sponse to physical rigors (Tedeschi & Calhoun. 1995).
Those who are already very fit will experience little ad-
ditional benefit compared with those who are moder-
ately capable. And. persons who have serious physical
limitations and weaknesses may have insufficient re-
sources to benefit much at all from rigorous physical
activity.
Posttraumatic growth may be a construct that is
more applicable to adolescents or adults than to young
children. because posttraumatic growth implies an es-
tablished set of schemas that are changed in the wake
of trauma. We might also expect that younger people
will report more growth than much older people, as the
young may be open to the learning and change of this
process to a greater degree than the old. who might
have already learned their life lessons. This has been
reported in at least one study using a sample with a
large age range (Powell. Rosner. Butollo. Tedeschi. &
Calhoun.2003).
There is little work with adolescents or children to
clarify the action of posttraumatic growth at these ages
(Milam. Ritt-Olsen. & Unger, 2001). We have begun
to develop a measure of posttraumatic growth for chil-
dren that shows promise in picking up some changes
akin to those reported by adults (Cryder, Tedeschi,
Calhoun, & Kilmer, 2002).
The Process of Posttraumatic Growth
The Traumatic Event
As others have suggested (Epstein, 1990;
Janoff-Bulman, 1992; Parkes, 1971) we assume that
individuals develop and rely on a general set of beliefs
4
POS1TRAUMA TIC GROWTH
[Trauma forces a person] to be somebody else, the next
viable you-a stripped-down whole other clear-eyed
person, realistic as a sawed-off shotgun and thankful
for air, not to speak of the human kindness you'll meet
if you get normal luck. (p. 183)
The perspectives of persons surviving terrible
trauma have in common the valuing of what has hap-
pened tQthem in the aftermath of trauma; that is, the
-growth they have experienced in their attempts to cope
Dr survive. The trauma itself remains a distressing
event. It appears that few people consciously and sys-
tematica))y intend to make meaning out of trauma or to
benefit from it. Posttraumatic growth is most likely a
consequence of attempts at psychological survival, and
it can coexist with the residual distress of the trauma.
Wright ( 1989) made this clear in describing how dis-
ability can be experienced:
The point is, however, that appreciating a disability,
giving it value, need not require that it be preferred in
and of itself; just that its ramifying meaning is valued
...It is then that the disability, being viewed within a
broader life context of a dauntless human spirit, be-
comes appreciated for what it signifies. (p. 528)
The affective quality of the learning and change in
posttraumatic growth may distinguish it from other
normative developmental processes that lead people to
report that they have been improving or maturing over
time. Because of the affect involved, and the restruc-
turing of the fundamental components of the assump-
tive world, growth seems to have a qualitative and
quantitative difference in trauma survivors. Their attri-
butions that growth was accomplished because of, and
in the aftermath of, the struggle with trauma may be ac-
knowledgments that much cognitive processing and
affective engagement went into the changes they re-
port. Research indicates that when persons who have
experienced severe trauma have been compared with
those who do not report trauma, positive personal
changes are reported at a reliably higher level among
trauma survivors (Tedeschi & Calhoun, 1996). How-
ever, even persons who have not experienced trauma
report some growth, indicating that there may be a ten-
dency to perceive oneself as changing positively in
general, and not onl y as a result of lessons learned from
traumatic events (McFarland & Alvaro, 2000).
and assumptions about the world, that guide their ac-
tions, that help them to understand the causes and rea-
sons for what happens, and that can provide them with
a general sense of meaning and purpose. Parkes ( 1971 )
called this general constellation the "assumptive
"world" and indicated that it "includes everything we
know or think we know" (p. 103). The assumptive
world provides individuals with the general perspec-
tives, or paradigms (Kuhn, 1970) within which they
operate. Major life crises can present major challenges
to the person's understanding of the world.
Growth, however, does not occur as a direct result
of trauma. It is the individual's struggle with the new
reality in the aftermath of trauma that is crucial in de-
termining the extent to which posttraumatic growth
occurs. We have used the metaphor of an earthquake
to describe this process (Calhoun & Tedeschi, 1998).
A psychologically seismic event can severely shake,
threaten, or reduce to rubble many of the schematic
structures that have guided understanding, decision
making, and meaningfulness. Psychological crisis
can be defined in relation to the extent to which the
fundamental components of the assumptive world are
challenged, including assumptions about the benevo-
lence, predictability, and controllability of the world;
one's safety is challenged, and one's identity and fu-
ture are challenged (Janoff-Bulman, 1992). The
"seismic" set of circumstances severely challenges,
contradicts, or may even nullify the way the individ-
ual understands why things happen, in terms ofproxi-
mate causes and reasons, and in terms of more
abstract notions involving the general purpose and
meaning of the person 's existence. Such threats to the
assumptive world are accompanied by significant
levels of psychological distress.
Extending our seismic metaphor, cognitive pro-
cessing and restructuring may be comparable to the
physical rebuilding that occurs after an earthquake.
The physical structures can be designed to be more re-
sistant to shocks in the future, as the community learns
from the earthquake what has withstood the shaking
and what has not. Cognitive rebuilding that takes into
account the changed reality of one's life after trauma
produces schemas that incorporate the trauma and pos-
sible events in the future, and that are more resistant to
being shattered. These results are experienced as
growth.
Domains of Posttraumatic Growth
The Personal Experience
The Posttraumatic Growth Inventory (PTGI;
Tedeschi & Calhoun, 1996), which measures five do-
mains of growth, was developed to allow quantification
of the experience of growth. The items on the scale were
developed out of a review of the literature on responses to
highly stressful events and from interviews conducted
with persons who had experienced spousal loss, physical
disabilities, and other life crises. The items were fac-
The psychological processing of the crisis events
has a highly emotional element connected to it. What
makes these experiences transformative seems to be
that they have this affective component, so that the les-
sons learned are not merely intellectual reflections.
Writer Reynolds Price (1994) described his paralysis
from cancer this way:
5
TEDESCHI & CALHOUN
better. Things that used to be big deals aren't big deals
to me anymore. Like big crisis problems, they will ei-
ther work out or they won 't. Whichever way it goes,
you have to deal with it." The identification of strength
is often correlated, almost paradoxically, with an in-
creased sense of being vulnerable. Growth in this do-
main is experienced as a combination of the clear
knowledge that bad things can and do happen and the
discovery that "if I handled this then I can handle just
about anything."
Posttraumatic growth can also be seen in the indi-
vidual's identification of new possibilities for one's
life or of the possibility of taking anew and different
path in life. One of the people who talked with us about
her personal loss was influenced by her own struggle
with grief to become an oncology nurse, where she
could try to provide care and comfort to other persons
facing suffering and loss.
Growth in the domain of spiritual and existential
matters is another way in which some persons experi-
ence positive change in their struggles with stress and
loss. As one person said:
You think about getting through something like that
and it's downright impossible toeven conceive ofhow
you ever could. But that's the beauty of the thing. ..it's
gonna have to be said because I believe that God got
me through it. Five or six years ago I didn't have these
beliefs. And I don't know what I would do without
Him now.
Individuals who are not religious, or who are ac-
tively atheistic, can also experience growth in this do-
main. There can be a greater engagement with
fundamental existential questions and lhat engagement
in itself may be experienced as growth.
Each of the five domains of posttraumatic growth
tends to have a paradoxical element to it that represents
a special case of the general paradox of this field: that
out of loss there is gain. For example, in the situation
where people are more limited in what choices they
have in life, such as becoming reliant on a wheelchair
for mobility, there may be a willingness to explore op-
portunities never before considered, such as a radical
change of vocational paths. At a time when one is vul-
nerable as never before, there is a sense of strength.
Out of spiritual doubt there can emerge a deeper faith.
Recognition of these paradoxes engages trauma survi-
vors in dialectical lhinking that is similar to that de-
scribed in the literature on wisdom (Baltes, Staudinger ,
Maercker, & Smith, 1995) and integrative complexity
(Porter & Suedfeld, 1981 ).
Although perhaps unnecessary, a reminder may be
in order. This description of the domains of
posttraumatic growth is positive, because the experi-
ence of growth is viewed that way. However, the pres-
ence of growth does not necessarily signal an end to
tor-analyzed, producing a 21-item scale with five factors
that define the ma.jor domains of posttraumatic growth:
greater appreciation of lite and changed sense of priori-
ties; warmer, more intimate relationships with others; a
greater sense of personal strength; recognition of new
possibilities or paths for one's life; and spiritual develop-
ment {Tedeschi & Calhoun, 1996). Our impression is that
these items do a good job of covering the reported experi-
ences of posttraumatic growth. We have nOl seen re-
search that indicates that other types of growth are
reported that are not generally represented in this scale.
However, it remains to be seen if the five domains hold
up in factor analyses of various samples of trauma survi-
vors (Maercker & Langner, 2001). A recent study of
Bosnian war refugees, for example, shows a slightly dif-
terent t"actor structure in a translated and altered version
of the IYrGI (Powell et al., 2003).
An increased appreciation for life in general, and
many smaller aspects of it, along with a changed sense
of what is important, is a common element in the expe-
rience of many persons who have struggled with major
difficulties. As Jordan (2000) put it, "even the smallest
joys in life took on a special meaning" (p. 216). Indi-
viduals typically report this as a major shift in how they
approach and experience their daily lives. This sense of
"being so lucky" is not uncommon. A radically
changed sense of priorities can accompany the in-
crease in appreciation for what one still has. Atypical
change iri priorities is an increase in the importance of
what before might have been considered the "little
things," such as a child's smile and spending time with
a toddler, and the recognition of the importance of
things tormerly taken for granted.
Closer, more intimate, and more meaningful rela-
tionships with other people can also be part of the indi-
vidual's experience of posttraumatic growth. A study
of posttraumatic growth in bereaved parents has pro-
vided us wilh some good examples of this change
(Calhoun, Tedeschi, Fulmer, & Harlan, 2000). As one
bereaved parent said, "When he died people just came
out of the woodwork. ..1 realize that relationships with
people are really important now. ..and I cherish my
husband a lot more." However, the experience of
deeper and more meaningful relationships can occur
along with the loss or disappearance of other relation-
ships, because, as one person said "you find out who
your real friends are in a situation like this." The expe-
rience of an increased sense of compassion, particu-
larly for others who now share the same difficult fate,
is another way in which the greater connection to oth-
ers occurs. As another bereaved parent said, "I've be-
come more empathetic towards anybody in pain and
anybody in any kind of grief."
A general sense of increased personal strength, or
the recognition of possessing personal strength, is an-
other domain of posttraumatic growth. Another be-
reaved parent reported to us: "I can handle things
6
POSTrRAUMATIC GROWTH
pain or distress, and usually it is not accompanied by a
perspective that views the crisis, loss, or trauma itself
as desirable. Many persons facing devastating trage-
dies do experience growth arising from their struggles.
The events themselves, however, are not viewed as de-
sirable-only the good that has come out of having to
face them. .
individuals will experience posttraumatic growth.
Next we suggest that the degree to which individuals
engage in self-disclosure about their emotions and
about their perspective on their crisis, and how others
respond to that self-disclosure, may also playa role in
growth. Then we describe how the cognitive process-
ing of the traumatic event, particularly the process of
ruminative thought, is related to growth; we argue that
how the individual cognitively processes the crisis
plays a crucial role in the process of posttraumatic
growth. Finally, we suggest that posttraumatic growth
can be connected to significant development of wis-
dom and of the individual's life narrative.
The Process of Posttraumatic Growth
Varieties of Trauma and Levels of
Posttraumatic Growth
Although we contend that it is not the trauma itself
that is responsible for growth as much as what happens
in the aftermath of trauma, it is important that the
events are challenging enough to the assumptive world
Now we consider in more detail what processing
trauma into growth enlails. Figure I (Calhoun &
Tedeschi, 1998) provides a general overview of what
we think lhis process is. Drawing both on empirical
work in the area and on our experiences as practicing
psychologists, we have proposed that posttraumatic
growth involves a variety of elements and we discuss
lhem next.
We begin by briefly describing some of the individ-
ual characterislics and lhe slyles of managing distress-
ing emolions that may increase the likelihood that
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7
TEDESCHI & CALHOUN
to set in motion the cognitive processing necessary for
growth. There are several studies that allow some ten-
tative comparisons between traumatic events and lev-
els of reported growth on the PTGI, with the caveat
that of course the sample characteristics also differ in
many ways. Some of the lowest reported scores come
from a study of criminal victimization in South Africa
(PTGI total M =40; Peltzer, 2000), whereas the highest
come from a small subsample of college students re-
porting the highest levels of severity of trauma
(Tedeschi & Calhoun, 1996), although the events
themselves varied (PTGI M = 83). Other studies have
typically reported intermediate scores; for example,
bereaved parents (PTGI M = 60; Polatinsky & Esprey,
2000), World War II bombing victims (PTGI = 69 on
scores transformed to standard scoring system;
Maercker & Langner, 2001), and women with breast
cancer (PTGI M = 58; Weiss, 2002).
Of course, only prospective, longitudinal research de-
signs will be able to demonstrate conclusively whether
certain pretrauma personality characteristics allow for
posttraumatic growth.
Although we have also found a positive relation be-
tween optimism and PTGI scores (Tedeschi &
Calhoun, 1996), this is also a rather modest correlation
(r= .23). This indicates that posttraumatic growth and
optimism may well be distinct concepts. The way opti-
mism may be related to posttraumatic growth may
again be through the influence it has on cognitive pro-
cessing. Specifically, optimists may be better able to
focus attention and resources on the most important
matters, and disengage from uncontrollable or unsolv-
able problems (Aspinwall, Richter, & Hoffman, 2001 ).
This ability may be especially important in the cogni-
tive processing that occurs in the aftermath of trauma,
as we discuss later.
Individual Characteristics
Managing distressing emotions. The person
facing a major life crisis must find ways of managing
initial distress, which can often be debilitating. This is
necessary to allow some degree of constructive cogni-
tive processing to occur, producing schema changes
that will contribute to the experience of posttraumatic
growth. At the early stages of response to trauma, cog-
nitive processing is more likely to be automatic; that is,
there are many occasions for intrusive thoughts and im-
ages, and negative intrusive rumination is typically fre-
quent. Eventually, if this process is effective, it leads to
disengagement from previous goals and assumptions,
as it becomes clear that the old way of living is no lon-
ger appropriate in radically changed circumstances.
We say "eventually," because this process can take
some time. Many people who survive traumatic events
report that many months later they can still be struck by
a sense of disbelief. To an extent, this process may in-
volve "grief-work" in the sense that the loss involved in
the trauma is gradually accepted. This often lengthy
process during which distress persists may actually be
important for the maximum degree of posttraumatic
growth to occur. This distress keeps the cognitive pro-
cessing active, whereas a rapid resolution is probably
an indication that the assumptive world was not se-
verely tested, and could accommodate the traumatic
events.
Support and disclosure. Supportive others can
aid in posttraumatic growth by providi ng a way to
craft narratives about the changes that have occurred,
and by offering perspectives that can be integrated
into schema change (Neimeyer, 200 I; Tedeschi &
Calhoun, 1996). We have emphasized the important
role ofmutual support in particular, because thecred-
ibility of those who have "been there" can be crucial
Personality characteristics. There appear to be
two basic personality qualities that may affect the like-
lihood that people can make positive use of the after-
math of traumatic events that befall them: extraversion
and openness to experience. In our original JYfGI vali-
dation sample we found some indications that openness
to experience and extraversion, as measured by the
NEO Personality Inventory (Costa & McCrae, 1992),
are modestly related to posttraumatic growth, whereas
other Big Five personality dimensions tended not to be
related. Scores on all five factors of the JYfGlcorrelated
reliably but quite modestly with extraversion (ranging
from a correlation of .15 between personal strength and
extraversion to a correlation of .28 between
extraversion and relating to others). Scores on only two
of the JYfGI factors correlated reliably with openness (r
= .25 both tor new possibilities and for personal
strength). The specific facets of the NEO that we found
to be most strongly related to the PTGI were activity (r
= .31 ), positive emotions (r= .34), and openness to feel-
ings (r= .28). Perhaps persons with these three charac-
teristics will be aware of positive emotions even in ad-
versity, and will be able to process information about
these experiences more effectively, producing the
schema change reported as posttraumatic growth. In-
deed, there is good evidence that positive afTect is im-
plicated in this kind of information processing
(Aspinwall, 1998).
Especially interesting is the lack of relation between
neuroticism and posttraumatic growth. Park ( 1998)
pointed out that positive and negative aspects of ad-
justment may be independent, and that compared to
persons who report only positive change, those who re-
port both positive and negative changes show more
growth (Taylor, Kerneny, Reed, & Aspinwall, 1991).
8
~
POSTrRAUMATIC GROWTH
Rumination or Cognitive Processing
in determining the degree of willingness trauma sur-
vivors have to incorporate new perspectives or
schemas (Tedeschi & Calhoun, 1993). Narratives of
trauma and survival are always important in
posttraumatic growth, because the development of
these narratives forces survivors to confront ques-
tions of meaning and how it can be reconstructed
(McAdams, 1993; Neimeyer, 200 I ). In telling these
stories to others, the emotional aspects of the events
and the survivor are usually revealed, resulting in an
intimacy that may be surprising. In bereaved parent
support groups we have often heard group members
talk about the group being their family, because they
have revealed more and been accepted more than in
any other personal relationship. The narratives of
trauma and growth may also hav~ the effect of
spreading the lessons to others through vicarious
posttraumatic growth. These stories then transcend
individuals, and can challenge whole societies to ini-
tiate beneficial changes (Bloom, 1998; Karakasian,
1998; Tedeschi, 1999).
Cognitive Processing and Growth
O'Leary, Alday, and Ickovics (1998) summarized
various models of change that could be useful in under-
standing the process of posttraumatic growth. Among
several of these models there is a common concern
with how the usual homeostatic mechanisms of
self-regulation can be abruptly altered, and a new pat-
tern of functioning emerges (Aldwin, 1994; Carver &
Scheier, 1998; Miller & C'deBaca, 1994 ). Aldwin and
Carver both used dynamic systems models to account
for the process of posttraumatic growth. Aldwin
( 1994 ), in describing transformational coping, posited
that individual differences in coping abilities set some
people on a maladaptive spiral, whereas others proceed
on an adaptive spiral. This deviation-amplification
process fits with our mode] that some early success in
coping is a precursor to later posttraumatic growth.
Carver ( 1998) described a catastrophe model that in-
cludes a deviation-reducing mechanism. He predicted
that self-confidence in coping and the importance of
the events interact to determine the degree to which
people engage in coping or give up. When events are
very important, people with high confidence persist to-
ward reducing the discrepancy between their circum-
stances and optimal functioning, and those with low
confidence give up. In our conception of posttraumatic
growth, there is the additional complication that people
who report growth must disengage, or give up, certain
goals and basic assumptions, at the same time persist-
ing in an attempt at building new schemas, goals, and
meanings. This persistence in cognitive processing
should be associated with posttraumatic growth.
To some extent this idea that persistent cognitive
processing is associated with growth is surprising,
given the body of evidence that demonstrates a relation
between certain types of rumination and negative af-
fect and depression (e.g., Horowitz, 1986;
Lyubomirsky, Caldwell, & Nolen-Hoeksema, 1998;
Nolen-Hoeksema & Morrow, 1991). It has been
pointed out that this evidence for the long-term draw-
backs to rumination does not seem to square with the
idea that it is involved in posttraumatic growth
(Updegraff & Taylor, 200 I ), Because the typical affec-
tive experiences of trauma survivors appear to be qual-
itatively different from what is seen in clinical
depression (Robinson & Fleming, 1992), we might ex-
pect that depressogenic rumination may be different
from that associated with posttraumatic growth. Rumi-
nation's perceived relation with negative outcomes
also may be due to the now common restrictive use of
the term to apply exclusively to negative, self-punitive
thinking (e.g., Nolen-Hoeksema, McBride, & Larson,
1997).
In contrast, Martin and Tesser ( 1996) recognized
"several varieties of recurrent [event-related] thinking,
including making sense, problem solving, reminis-
cence, and anticipation" (p. 192). They proposed a def-
inition that incorporates the common features of
rumination found in previous work and they described
rumination as thinking that (a) is conscious; (b) re-
volves around an instrumental theme; and (c) occurs
without a direct cueing from the environment. but is
easily and indirectly cued because it is connected with
important goals, leading to recurrent thoughts. They
categorized modes of ruminative thought as referring
to the past, present, or future regarding negative or pos-
itive events.
The event-related rumination can involve goal at-
tainment or a discrepancy involving unattained goals
or lack of fit between schemas and events that have oc-
curred. In coping with life crises, people are concerned
with the negative events with a discrepancy focus.
Martin and Tesser (1996) categorized the thinking
about the past as working through, the present as cur-
rent concerns, and the future as worry. To distinguish
the type of recurrent negati ve thinking that has been la-
beled rumination by many other researchers from the
processes referred to by Martin and Tesser, we use the
term cognitive processing, but we rely on Martin and
Tesser's concepts about rumination in considering t~e
kind of thinking that leads trauma survivors toward
growth.
It appears that as survivors reflect on the discrep-
ancy involving unattained goals or schemas and
events, they develop the universal character of the
trauma narrative-the before and after the trauma, the
trauma as turning point (McAdams, 1993; McAdams,
9
TEDESCHI & CALHOUN
Reynolds, Lewis, Patten, & Bowman, 2001; Tedeschi
& Calhoun, 1995). A goal was possible then, but not
now. A philosophy or belief may have ...eemed true
then, but not now. This is particularly the case when
the goals or schemas are high order (they are general or
fundamental, related to identity and purpose) and ,ap-
pear not only to be unattained, but now because of the
trauma, are unattainable. The disengagement from the
unattainable goals or the worldview that cannot ac-
commodate the reality of the trauma can allow the
trauma survivor to formulate new goals and
worldviews that allow a perception that one is moving
forward again toward goals in a world that permits this.
As Little ( 1998) pointed out, the sense of movement
toward achieving goals is crucial in life satisfaction.
There is probably not a clear distinction between the
discrepancy focus involving unattained, and appar-
ently unattainable, goals and the general schemas that
represent fundamental assumptions about one's life
and the world. Both involve giving up dearly held
goals that survivors had assumed they would be able to
attain, as when a bereaved parent is forced to give up
dreams and expectations for achild's life. We also sub-
mit that the presence of posttraumatic growth does not
necessarily mean a lessened degree of psychological
distress. Virtually everyone reporting posttraumatic
growth also acknowledges at least some distress. What
they went through cannot be accommodated easily,
and losses have been suffered. This "past" temporal
orientation, a focus on what has been lost, is related to
poorer outcomes (Holman & Silver, 1998), but is also
realistically acknowledged by the vast majority of
those reporting posttraumatic growth. Consider Rabbi
Harold Kushner's reflection on the death of his son:
counLerfacLual ruminaLion is ulLimaLely in Lhe service
of making sense of evenLs in Lhe lighL of shattered as-
sumpLions. Following Lhis cogniLive processing long
enough to see Lhese ouLcomes is the only way thaL re-
searchers will be able Lo undersLand Lhe convoluted
process of cognitive processing involved in
postLraumaLic growLh.
When cognitive processing is followed over time,
changes in its quality may become evidenL. In our clin-
ical work, we believe we observe such changes, but
empirical longitudinal studies are needed to confirm
this. Initially, Lrauma survivors typically report inlru-
sive Lhoughts and images that are highly distressing.
There may also be attempts to comprehend and man-
age the aftermath of trauma (Tedeschi & Calhoun,
1995). This is meaning as comprehensibility that can
be distinguished from meaning as significance (Davis,
Nolen-Hoeksema, & Larson, 1998; Tedeschi &
Calhoun, 1995). Initial revisions of schemas that pro-
duce comprehensibility may be an intermediate step to
posttraumatic growth. The negative cognitive pro-
cesses set in motion by major life crises are difficult to
distinguish from positive ones, because the destruction
wrought by such crises to higher order goals and
schemas also allows for schema reconslruction based
on new principles, recognition that trauma is a personal
reality, and a definition of self as a survivor. For exam-
ple, a musician we interviewed suffered permanent pa-
ralysis and cognitively processed this loss by asking
himself "Who am I?" and "What will become of my
life?" These disturbing questions also represented an
orientation toward the future, producing more healthy
processing of the lrauma into revised goals and
schemas. We quoted him at the beginning of our first
book on this topic:
I am a more sensitive person, a more effective pastor, a
more sympathetic counselor because of Aaron's lite
and death than I would ever have been without it. And I
would give up all of those gains in a second if I could
have my son back. I f I could choose, I would forego all
of the spiritual growth and depth which has come my
way because of our experiences ...But I cannot
choose. (Yiorst, 1986, p. 295)
This was the one thing that happened in my life that I
needed to have happen, it was probably the best thing
that ever happened to me. ...Ifl hadn't experienced this
and lived through it.llikely wouldn't be here today be-
cause of my lifestyle previously-1 was on a real
self-destructive path. If I had it to do allover again I
would want it to happen the same way. I would not want
it not to happen. (Tedeschi & CaJhoun. 1995. p. I)
Another kind of cognitive activity that seems re-
lated to higher levels of distress is regret and repeated
consideration of how the trauma could have been
avoided (Greenberg, 1995). These "counterfactuals"
have a past temporal orientation and appear to be asso-
ciated with negative affect. In their studies of
counterfactual thinking among bereaved parents and
patients with spinal cord injuries, Davis and Lehman
( 1995) found that such thoughts occurred even when
causes of the traumatic events were clear and there was
evidence of others' roles in causing the trauma. Al-
though this cognitive processing of counterfactuals
can persist for years, Davis and Lehman concluded that
Data from recent studies provide some support for
the hypothesized relation between cognitive process-
ing and posttraumatic growth. In a study (Tedeschi,
Calhoun, & Cooper, 2000) of a group of older adults
who reported on experiences with trauma, growth at-
tributed to the struggle with the two events in their
lives they described as the most stressful was associ-
ated with the frequency of rumination across all trau-
matic events in their lives (r = .49, p < .01 ).
Unfortunately, the specific content of this rumination
was not obtained from the respondents. In a study of
bereaved HIV-positive men, there was a link between
10
POSTfRAUMA TIC GROWTH
lated to these kinds of thinking. These data appear to
demonstrate that understanding the type of cognitive
processing and when it occurs may be crucial to under-
standing the cognitive routes to posttraumatic growth,
and that different aspects of growth may be particu-
larly sensitive to certain kinds of cognitive activity at
different periods of time after trauma.
deliberate, repetitive cognitive processing and experi-
ences of personal growth (Bower et al., 1998). Simi-
larly, Ullrich and Lutgendorf (2002) found that college
students who used a journaling exercise reported
higher scores on the PTGI after 4 weeks if they had
been instructed to cognitively process the emotional
aspects of the traumas they were coping with: Focusing
on facts or emotions alone did not produce
posttraumatic growth. These findings fit with our
model, in that deliberate cognitive processing is crucial
to growth outcomes, and this processing is happening
somewhere in the time frame between intrusive, auto-
matic thinking and posttraumatic growth. In another
study, (Calhoun, Cann, Tedeschi, & McMillan, 2000),
young adult trauma survivors tended to report greater
posttraumatic growth when also reporting greater lev-
els of cognitive processing recalled as occurring soon
after the event (r= .32, p < .05), but not when engaged
in continuing processing years after the event. These
results are congruent with previous findings that con-
tinued and extended searches for meaning, perhaps
longer than a decade, bode poorly (Silver et al., 1983;
Tait & Silver, 1989).
Calhoun, Tedeschi, et al. (2000) examined the rela-
tion between different types of rumination in bereaved
parents who participated in mutual help support
groups. Items from various inventories were used to
assess five types of cognitive processing in reports
about experiences parents recalled as occurring soon
after their children's deaths and more recently. Mea-
sures of intrusive thinking, both recalled as occurring
soon after the child's death and recently, were unre-
lated to posttraumatic growth. Nonintrusive repetitive
thinking recalled as occurring in the immediate after-
math of the child's death was associated with
posttraumatic growth (r = .38, p < .05), but repetitive
thinking recently was not. Attempts at deliberate
meaning making recalled as occurring soon after the
death were related to posttraumatic growth (r = .48, p <
.01 ), but recent attempts al meaning making were not.
Finally, attempts at positive reinterpretation and bene-
fit reminding were related to posttraumatic growth
when engaged in recently (r = .36, p < .05; r = .44, p <
.05, respectively), but not soon after children's deaths.
In addition, these data showed that the different do-
mains of posttraumatic growth measured by the PTGI
were differentially related to cognitive processing. For
example, personal strength was the only domain re-
lated to repetilive thoughts soon after the children's
deaths (r = .48, p < .01 ), whereas all domains except
personal strength were related to attempts to make
sense of whal had happened soon after the deaths. Ap-
preciation of life was most strongly related to recent at-
tempts at positive reappraisal (r = .55, p < .001) and
benefil reminding (r= .55, p < .001), with new possi-
bilities somewhat less so (r = .46, p < .01; r = .36, p <
.05, respectively), and with other domains being unre-
Growth, cognitive processing, and disclosure.
The cognitive processing of trauma into growth ap-
pears to be aided in many people by self-~isclosure
in supportive social environments. It is unclear
whether this disclosure works better if it is written or
verbal, because there is evidence that posttraumatic
growth can be increased by specific interventions
that enhance cognitive processing during journal
writing (Ullrich & Lutgendorf, 2002). It may be that
the facilitation or discouragement of cognitive pro-
cessing of emotional material in trauma survivors is
the key, and this can happen in direct social contact
or through instructions to persons who write per-
sonal journals.
Lepore and associates (Lepore & Helgeson, 1998;
Lepore, Silver, Wortman, & Wayment, 1996) have
shown that social constraint (i.e., blocking of self-dis-
closure of intrusive thoughts) produces a strong rela-
tion between these thoughts and depression.
Nolen-Hoeksema and Davis (1999) reported, in their
study of bereaved persons over 18 months, that people
with a ruminative coping style sought out more social
support, although they at first were less comfortable
talking than nonruminators. However, the ruminators
ended up benefitting more from the support, helping
them avoid becoming depressed. Reporting on the
same data, Nolen-Hoeksema and Larson ( 1999) found
that seeking social support produced posttraumatic
growth in two of the four waves of interviews over 18
months, and that this may be because many persons
sought support but did not find it.
Social support may playa strong role in the devel-
opment of posttraumatic growth when it remains stable
and consistent over time. For example, Heindrich and
Ryff (1993) found that greater social integration buf-
fered elderly women with health problems and pro-
duced greater sense of well-being. Powell et al. (2003)
found differences in posttraumatic growth among per-
sons who experienced the war in Sarajevo. In this
study, persons who had fled the country and been in so-
cially stable environments reported more growth than
those who endured the entire conflict in the city. A
more direct test of the relation between posttraumatic
growth and social support is found in a study of breast
cancer survivors (Cordova, 1999; Cordova et al.,
2001 ). When friends and family did not wish to hear
from cancer patients about their illness, cognitive pro-
cessing appeared to be inhibited. The less cognitive
II
TEDESCHI & CALHOUN
and after the war, before and after the stock market
crash, or before and after the criminal assault, for ex-
ample (Tedeschi & Calhoun, 1995). The struggle with
traumatic events can lead, along with the possibility of
posttraumatic growth, to a revised life story
(McAdams, 1993). As the graphic representation of
our model of posttraumatic growth suggests (Figure I),
the development of the individual's personal life narra-
tive and posttraumatic growth may mutually influence
one another .
Ongoing and Interactive
One of the questions that can be raised about
posttraumatic growth is whether it is a process or an
outcome. We think of it as being both. Our assumption
is that a variety of factors in different domains interact
with, influence, and are influenced by posttraumatic
growth. This general pattern of mutual influences un-
folds over time. For most persons this active process
tends to taper off with time, but the few available lon-
gitUdinal studies in this area suggest that there may be
different temporal patterns for different aspects of
growth, and there may be significant variation between
individuals (e.g., Frazier et al., 2001).
processing, the less posttraumatic growth was reported
by the survivors.
Another study of breast cancer survivors and their
husbands also supports the hypothesis that
posttraumatic growth is positively influenced by social
support. Weiss (2000, 2002) reported that. the
posttraumatic growth of wives was a significant pre-
dictor of husbands' posttraumatic growth, and that this
was not related to reported degree of marital conflict.
General social support was also related to
posttraumatic growth, and to acknowledgment of fear
among husbands. Weiss suggested that the relation be-
tween posttraumatic growth and social support may be
due in part to the tolerance of distress that sustains cog-
nitive processing.
We have previously emphasized the potential bene-
fits of social support experiences in facilitating
posttraumatic growth through mutual support groups,
because they provide "discussion of perspective, offer-
ing of beliefs, and the use of metaphor to explain expe-
rience. All of this is fertile ground for the revision of
schemas that is essential to the experience of growth"
(Calhoun & Tedeschi, 1999, p. 68). The only published
data we are aware of testing the notion that
posttraumatic growth can be actively promoted in
groups is a study by Antoni et al. (200 I ). These re-
searchers looked at perceptions of benefit from ex peri-
encing cancer using a 100week group-based
cognitive-behavioral stress management intervention
for women with early-stage breast cancer. Women
who were low in optimism, in contrast to those high in
optimism, had a greater increase in reported benefits
from the cancer experience over 3- to 6-month fol-
low-up. Emotional processing was also related to re-
ported perceptions of benefit, but not optimism.
General Summary or the Process
As we have conceptualized it, the process of
posttraumatic growlh is sel in motion by the occur-
rence of a major life crisis that severely challenges and
perhaps shatlers the individual's understanding of the
world and his or her place in it. Certain kinds of per-
sonal qualities--extraversion, openness to experience,
and perhaps oplimism-may make growth a hil more
likely. Initially, the individual typically must engage in
coping responses needed to manage overwhelming
emotions, but intense cognilive processing of the diffi-
cult circumstances also occurs. The degree to which
the person is engaged cognitively by the crisis appears
to be a central element in the process of posttraumatic
growth. The individual's social system may also play
an important role in the general process of growth, par-
ticularly through the provision of new schemas related
to growth, and the empathetic acceptance of disclo-
sures about the traumatic event and about growth-re-
lated themes. Posttraumatic growth seems closely
connected to the development of general wisdom
about life, and the development and modification of
the individual's life narrative. Although posttraumatic
growth has been found to be correlated with a reduc-
tion of distress, our thinki ng is some degree of psycho-
logical upset or distress is necessary not only to set the
process of growth in motion, but also some enduring
Wisdom and Narrative Development
Our assumption is that as individuals expt:rience
posttraumatic growth, these changes have an ongoing,
mutual influence with the development of general wis-
dom about life and further development of the general
framework, the narrative, people have for thinking
about their lives. Posttraumatic growth shares some
common foundations with what has been described as
the "fundamental pragmatics of life" (Baltes & Smith,
1990, p. 21 ). Persons who have faced major challenges
in their lives may also develop "the ability to balance
reflection and action, weigh the known and the un-
knowns of lite, be better able to accept some of the par-
adoxes of lite, and to more opt:nly and satisfactorily
address the fundamental questions of human exis-
tence" (Calhoun & Tedeschi, 1999, p. 21 ).
For persons who have experienced ma.jor life crises,
their lives are often conceptualized as having a before
and after: before and after the loss of the baby, before
12
~
POSTfRAUMA TIC GROWTH
upset may accompany the enhancement and mainte-
nance of posttraumatic growth.
Posttraumatic Growth and Physical
Functioning
We are aware of only one study that has looked at
the relations between posttraumatic growth and physi-
cal well-being. Epel, McEwen, and Ickovics ( 1998) re-
ported that of the five factors of the PTGI, elevations
on spiritual growth and appreciation of life were re-
lated to quicker cortisol habituation to a laboratory
stressor. Similarly, Bower et al. (1998) found that men
with HIV were less likely to have rapid declines in
CD4 T -cell levels if they cognitively processed their
situation into something meaningful. These men also
had lower levels of mortality, regardless of health sta-
tus at the start of the study or health-related behavior.
This finding echoes the earlier study of Affleck et al.
(1987), who reported lower rates of mortality in heart
attack victims who derived benefits from their illness.
Much work remains to be done in exploring the links
among cognitive processing, posttraumatic growth,
and health-related outcomes, but these studies suggest
this may be a promising area for investigation.
Posttraumatic Growth and
Psychological Distress
An important issue addressed in the published re-
search on posttraumatic growth is the degree to which
higher levels of growth are associated with lower lev-
els of psychological distress. The quantitative evi-
dence is mixed. Where relations are observed, higher
levels of growth tend to be associated with lower levels
of distress (Frazier et al., 2001; Park et al., 1996).
However, other investigations have found no reliable
relation between posttraumatic growth and distress
(Cordova et al., 2001; Powell et al., 2003). Further,
some studies indicate a significant relation between
measures of intrusive thoughts and posttraumatic
growth (Calhoun, Cann, et al., 2000).
How do we reconcile the reports of rumination re-
lated to depression and our findings of cognitive pro-
cessing related to posttraumatic growth'? Posttraumatic
g~owth and distress are essentially separate dimen-
sions, and growth experiences do not put an end to dis-
tress in trauma survivors (Calhoun & Tedeschi, 1998;
Tedeschi & Calhoun, 1995). These distinctions are
seen in a study by Cordova et al. (2001 ). Matching
breast cancer survivors with healthy controls, they
found that cancer survivors and controls were no dif-
ferent in levels of depressive symptoms, although the
cancer survivors reported more posttraumatic growth.
Depression, intrusive thinking, and general personal
well-being were all unrelated to posttraumatic growth.
Instead, posttraumatic growth was related to perceived
threat of the cancer experience and talking with others
about it. It appears that in general, there are surpris-
ingly few relations between posttraumatic growth and
apparently related variables such as well-being, opti-
mism, and (low) depression, or (low) neuroticism.
Park (1998) suggested that the failure to find a neg-
ative relation between growth and distress occurs be-
cause some people reporting growth may deny
negative aspects of their experiences, whereas others
do not (e.g., Taylor et al., 1991), and that domains of
posttraumatic growth are conceptually distinct from
general emotional adjustment. Continuing levels of
manageable distress may actually fuel posttraumatic
growth, as suggested in our model (Calhoun &
Tedeschi, 1998). The available data suggest that expe-
riencing higher levels of posttraumatic growth is corre-
lated with, and perhaps may result in, reduced levels of
psychological distress, but not always.
Is the lack of relation between distr.ess and growth
not a limitation of the concept? We think not. As we
have indicated, the absence of consistent relations sug-
gests that posttraumatic growth and traditional mea-
sures of psychological adjustment are independent.
Posttraumatic growth is not the same as an increase in
well-being or a decrease in distress. In addition, the im-
petus for growth is the individual's struggle with a
highly distressing set of circumstances that signifi-
cantly challenges people's understanding of the world
and their place in it. The maintenance of growth may
also require periodic cognitive and emotional remind-
ers that are not pleasant, of what has been lost, but par-
adoxically, also of what has been gained. As others
have suggested (Yalom & Lieberman, 1991 ), growth
and subjective pain may indeed coexist for some peo-
ple. The experience of posttraumatic growth may be
accompanied by a reduction in distress, but our model
does not predict such a relation.
Some studies just cited suggest repetitive thoughts
that are difficult to stop are related to posttraumatic
growth. Initial deliberate attempts to make meaning
and later attempts to interpret the aftermath positively
and bring the benefits to mind, may be reliably related
to posttraumatic growth. Active disclosure of thoughts
and emotions to empathetic others may be important to
the development of posttraumatic growth. However,
the development of measures of the complicated
cognitions associated with posttraumatic growth and
the longitudinal examinations of these processes await
the attention of researchers focusing on this area.
Understanding the relations among these thought
processes and the best outcomes for trauma survivors
is important in helping professionals who work with
such populations to discern the positive nature of the
apparently painful cognitive activity of these persons.
Attempts on the part of people in the support networks
13
TEDESCHI & CALHOUN
of trauma survivors to suppress rumination are per-
ceived by survivors as not helpful (Lehman, Ellard, &
Wortman, 1986; Lehman & Hemphill, 1990). Simi-
larly, therapeutic interventions with trauma survivors
that are focused on rapid distress relief may prevent
greater long-term gains (Calhoun & Tedeschi, 1999).
wide effort in the United States to eliminate drunk
driving, resulting in not only legal changes, but so-
cially shared recognition of the dangers of this activity,
a stigma about it, and even a new language including
such terms as designated driver. With these kinds of
determined leaders who wish to transform their own
experiences of trauma and the vicariously experienced
trauma of others, there can arise mutual support among
those with similar experiences, and in such support
there can be important social change.
Extension of the Concept to Social
Transformation
Other Routes to Growth
In the original validation study of the PTGI
(Tedeschi & Calhoun, 1996), we found that persons
who did not experience any trauma also reported
growth, although at lower levels than trauma survi-
vors. Although this may represent a self-enhancing
cognitive bias that allows people to claim ongoing
self-improvemenl. these results might also reflect rec-
ognition of a maturational process in the young adults
in that sample. The domains of growth represented by
the PTGI might be experienced to some degree
through other processes than massive schema violation
through trauma, perhaps by an accumulation of experi-
ence over time that produces gradual changes that
can't be attributed to single events.
Positive experiences might also have a similar ef-
fect on the domains of posttraumatic growth, espe-
cially if they are extraordinary enough to challenge
schemas the way traumatic events do. Peak experi-
ences and similar concepts (Csikszentmihalyi, 1990;
Maslow, 1971; Privette & Landsman, 1983) may rep-
resent some life-altering event that results in some of
the same changes that trauma survivors report. Con-
cepts of positive experiences, such as Maslow' s, do not
make clear how and why these experiences might pro-
duce changed life perspectives. Following our model,
positive life changes initiated by posilive events would
have to involve significant challenge to schemas and a
clear change in the life narrative, and lo accomplish
this, posilive experiences would need to combine the
affective and intellectual in learning this new view of
life. Empirical analyses would then be necessary to
compare posttraumatic growth with growth in the af-
termath of positive experiences to determine whether
they produce the same trajectories of change over time,
endure for the same periods, or have other similarities.
It should be apparent, however, that personal
growth probably has a common core, although it oc-
curs for different reasons. The five domains of the
PTGI are probably a good representation of the breadth
of growth that people can experience. Whatever the
catalyst might be for growth, there are bound to be
some biases introduced by the person experiencing the
Traumatic events happen not only to individuals,
but also to groups, and through vicarious processes, to
whole countries and societies. Therefore, we might
also consider how the concept of posttraumatic growth
might be applied to social change in the aftermath of
widespread trauma. Socially shared schemas can be
challenged and changed by traumas that are widely
shared, such as war or economic hardship (Bloom,
1998; Tedeschi, 1999). The social narrative can be
changed by the struggle with events,just as it is in indi-
viduals, creating a discussion about who "we" are in
the aftermath of the events, what principles should
guide the society, and what meaning the trauma has for
the society.
For example, the Great Depression of the 1930s
produced new ideas about the responsibility of govern-
ment to protect individuals from the excesses of capi-
talism. World War II transformed the combatants'
views of their societies and national character, and pro-
duced changes to socially shared schemas that are still
felt. Such a turning point in the social narrative in Ja-
pan marked a change from a strongly militaristic to a
more pacifistic culture. In Germany, the Holocaust has
had an enduring effect on the youth of the country as
they try to identify positively with their nation
(Brendler, 1995). The Vietnam War led Americans to
reconsider the role of morality and national consensus
in making war, and changed views of the trustworthi-
ness of government leaders. The attacks against the
World Trade Center in New York, on September II,
200 I, are being seen as a catalyst for social change, al-
though it is too early to tell exactly what those changes
might be.
Positive changes can arise out of such events when
the individual narratives are shared and integrated into
the social narrative in such away that the events are
recognized as turning points. Leadership is also impor-
tant. The famous and the unknown can emerge as im-
portant forces in changing the narratives and the
schemas of societies. In South Africa, Desmond Tutu
and Nelson Mandela gave powerful moral direction
that led to the breakup of apartheid and the establish-
ment of the Truth and Reconciliation Commission.
This group allowed for the telling of stories that rein-
forced changes in individual and social schemas.
Candy Lightner, a bereaved mother, started a nation-
14
POSTfRAUMATIC GROWTH
growth, because experience is inherently constructive
(Neimeyer & Stewart, 2000).
Richard G. Tedeschi, Department of Psychology,
UNC Charlotte, Charlotte, NC 28223. E-mail:
rtedesch @email.uncc.edu
Conclusion
References
Reports of posttraumatic growth are now well-doc-
umented and this aspect of the psychological responses
to major life crises should be regularly integrated into
research in this area. The phenomenon is complex, and
cannot easily be reduced to simply a coping mecha-
nism, a cognitive distortion, psychological adjustment
or well-being, or a host of apparently similar con-
structs. The outcomes of posttraumatic growth might
be best considered as iterative, and it will take longitu-
dinal work to trace the varied trajectories of the
posttraumatic growth process. This process is likely to
involve a powerful combination of demand for emo-
tional relief and cognitive clarity, that is achieved
through construction of higher order schemas that al-
low for appreciation of paradox. Metaphorical and nar-
rative elements are likely to serve trauma survivors
well as they take on a life that has become surprising,
complicated beyond expectation, and painful. Re-
searchers need to be focused on individual attempts to
navigate the aftermath of trauma to develop an overall
appreciation for these transformative processes.
We must also appreciate that trauma survivors often
do not see themselves as embarking on searches for
meaning or attempts to construct benefits from their
experiences. They are either attempting to survive or
trying to determine if survival is worthwhile. We have
noticed that posttraumatic growth tends to surprise
people, and has not usually been a conscious goal.
Therefore, we emphasize in our work that
posttraumatic growth is a consequence of attempts to
reestablish some useful, basic cognitive guides for liv-
ing, rather than a search for meaning or an attempt to
manage the terror of mortality (Davis &
Nolen-Hoeksema, 2001 ).
The overall picture of posttraumatic growth has
been sketched. Describing the details of cognitive pro-
cessing and narrative development will be much more
difficult, and will demand from researchers an intimate
knowledge of many literatures related to posttraumatic
growth, and of qualitative and quantitative analytic
procedures applied to long-term processes at the micro
and macro levels.
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