Welcome back to the Healing Pain Podcast with With Richard Tedeschi, Ph.D.
It’s one thing to experience tragic events in our lives and another to continue living life with trauma. If you are someone suffering from physical, psychological, and emotional trauma or someone who knows of anyone who is experiencing post-traumatic stress, this is the podcast for you. Richard Tedeschi, Ph.D., Psychologist and Distinguished Chair of Boulder Crest Institute for Posttraumatic Growth, talks about the concept of post-traumatic growth and how it differs from resilience. He also shares its five components and more about how trauma affects our heroes after rendering service. He gives us a glimpse into the programs that bring together veteran path guides to help train and support struggling veterans and their families to rediscover hope and purpose as they transition back to their lives out of duty.
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Trauma And Post-Traumatic Growth With Richard Tedeschi, Ph.D.
In this episode, we will explore and learn about the concept widely known as post-traumatic growth with its originator, Dr. Richard Tedeschi. Dr. Tedeschi’s clinical experience and research and the concept of post-traumatic growth span more than 40 years. Post-traumatic growth is a concept which describes the positive psychological, behavioral, and life-changing experience as a result of struggling with a highly stressful or distressing life circumstance.
In this episode, we discuss the five components of post-traumatic growth. The five components of post-traumatic growth are personal strengths, new possibilities, improve relationships, spiritual growth, and appreciation for life. Richard also developed the post-traumatic growth inventory, which we’ll speak about in this episode. This includes its research and clinical applications.
The focus of this episode is on the long-term process of post-traumatic growth, which entails the struggle it takes to overcome a traumatic event and one’s ability to reconstruct the shattered beliefs that occur as a result of coping with PTSD. We also talk about resiliency and post-traumatic growth and the relationship between the two. Finally, we talk about the ongoing distinguished work Richard is doing with an organization called Boulder Crest and a program called the Warrior PATH, which helps veterans and first responders overcome PTSD.
I would like to thank Richard for joining us and speaking to our community. I hope you all enjoy this episode and learn a lot that can help either yourself, your friends, your family or your patients and clients. Without further ado, let’s begin and learn about post-traumatic growth with Dr. Richard Tedeschi.
Richard, thanks for joining us on the show. It’s great to have you here.
Thanks, Joe. I’m looking forward to it.
I am too. As I mentioned before in our introduction, we’ve touched on this concept of post-traumatic growth once before in a previous episode. I was much interested in speaking with you one-on-one and introducing you to our community so we could go deeper on the topic. Many people know that you originated this concept about three decades ago. We’re all looking forward to this. As I was preparing for this episode, I look at your research and the books you’ve written, and a lot of the evidence that you’ve supported around.
The question that came to my mind was you originated this topic, but what was life like in the field of psychology, healthcare in general, and trauma before we had this conceptualization of post-traumatic growth? If you can take us back maybe three decades, how do we approach trauma without this idea that there is a possibility of post-traumatic growth?
Most of the work on trauma has been focused on symptoms of trauma, and how those symptoms create all kinds of other negative consequences for people. That work came out of the Vietnam War where post-traumatic stress disorder was first introduced to the Diagnostic and Statistical Manual. That was a real advance at the time because it got people looking at trauma in a way that they hadn’t before because that terminology hadn’t existed. Trauma has been something that has been evident to anybody in mental health since the beginning of the field. Freud first talked about it. It has been certainly an important part of mental health practice. In terms of post-traumatic growth changing things, post-traumatic growth is a term that I coined together with my colleague, Lawrence Calhoun, at UNC Charlotte back in 1995.
We use that term because we had been looking at the literature when we became interested in the whole idea that people have not only negative consequences from trauma but sometimes positive ones. We were looking at the literature and we found that people would talk about this, but there wasn’t a really good terminology for it. When we wrote our first book in ’95, we reviewed that literature and remarked upon the different ways that people would talk about post-traumatic growth without using that term. We were trying to figure out, “What should we call this thing?” I remember one day we came up with that term. That captures the quality of this in a way we want to. We think that people pay attention to it.
For example, one of the terms that we ran into in the literature that someone had used was positive byproducts. It doesn’t quite have a ring to it. It’s not going to attract a lot of positive attention, I don’t think. It didn’t. Another term that someone had used back in the 1970s and a couple of articles that appeared was strens. I still have no idea what that was supposed to mean. Anyway, people have been looking at this concept bit by bit, a little bit at a time. There’s no real presence in the literature in any organized fashion. We wanted to come up with some terminology that attracted people to the concept. It did take a while for that to happen.Growth happens in all kinds of ways for all sorts of reasons, not just because of trauma. Click To Tweet
There’s also a concept of positive growth that exists in the literature. I’m wondering if there’s a distinction between positive growth and post-traumatic growth, or synonyms for each other after a while.
Positive growth sounds redundant to me because growth is positive. I don’t know what negative growth would be. That doesn’t sound like a term that makes much sense to me. We’re talking about post-traumatic growth because we’re talking about the growth that comes in the aftermath of traumatic events. Growth happens in all kinds of ways for all sorts of reasons, not just because of trauma. We’re just focused on this particular version of growth that happens in the aftermath of traumatic events.
You mentioned some of the negative aspects of trauma, and some of the symptoms that practitioners are focused on. There should be a focus on somewhat the alleviation of physical as well as emotional symptoms. Can you give us an overview? It’s a big topic and I don’t want to just focus on neuroscience. What happens in the brain and the body when someone experiences a trauma that they adversely react to?
The experience is a natural and understandable experience. Trauma responses are built into all of us and other creatures too to protect ourselves so that we can survive whatever threat we’re confronting. All the physical manifestations of trauma or trauma response are built to help us to either fight or flight, to fight off some threat or run away from it. There’s also a freeze response. We’ve all experienced that where we’ve frozen on our path because something shocked or surprised us. These are the kinds of things that animals and people do. It’s built into the brain in a way that helps us to survive.
These responses are pretty much at a physical or physiological level. Human beings have more than that going for them. We’re intellectual too. Part of the trauma response that we also talk about when we refer to post-traumatic growth is a reconstruction process that has to occur when we don’t understand our environment anymore, and when our environment takes us by surprise and doesn’t look familiar in ways that we’ve come to understand. That’s another part of the trauma response that happens to people. There’s a physical manifestation of it. There’s more of a psychological intellectual manifestation of it.
All of this produces an emotional response to trauma. Emotions are closely connected with this physical response. The lack of understanding of a world that now looked strange and threatening is typically anxiety that’s part and parcel of what we find in post-traumatic stress disorder. Those are the sorts of things that are going on. When people come to me and they ask about their trauma symptoms, what’s wrong with them, and why these things are happening, I point out to them that it’s an alarm reaction that has become chronic or too easily tripped off. Their alarm is working fine. It’s just coming online at a time when they’re not in danger.
For example, at Boulder Crest, we’re doing a lot of work in the past several years. One of the things that we point out to people who come to our programs is, “It’s not what’s wrong with you. It’s what happened to you. There’s nothing wrong with your physical capabilities or your intellectual capabilities or your character, but what happened to you has generated these sorts of responses that are now troubling.” We have to try to get those mitigated. We have physical and psychological ways of trying to address that.
I can hear a lot of overlaps with chronic pain in your description there.
It’s a positive feedback loop where things end up in these vicious cycles. You find that in pain and emotional pain.
I always encourage people as they read this and as they grow with the information that we release that there is no difference between physical and emotional trauma at this point in our conceptualization of it because how those things are processed in the brain are similar. As we move forward in science, we’re seeing that there are many similarities between emotional pain and suffering, and physical pain and suffering, and how it starts to illuminate how we approach people who are suffering from both physical and mental health conditions.
Before I get to resilience, there was another word you used there, which is reconstruct. I don’t think it gets enough attention personally in the world of trauma. We’re focused on how we treat the nervous system that is responding to trauma, and how we treat a trauma response. It sounds like this idea of reconstruction takes a period of time. Someone has to reflect on what happened to them, what is that experience, and how has that experience now affected their thoughts and beliefs about the world they have to now negotiate. Can you talk to us about what’s involved in that reconstruction period?
Back in the early 1990s, Ronnie Janoff-Bulman of the University of Massachusetts wrote a book that was important called Shattered Assumptions. She talked about a concept of the assumptive world that had existed at least I know in the 1970s. This is the world that we assume to be real. We have a cognitive map of this world that we use to navigate it. We got ourselves through our everyday life, assuming that the world is a certain place. When a certain event happens or there are challenges to those assumptions, we become acutely anxious because now our map is not helpful to us anymore and we’re lost.Trauma responses are built into all of us so that we can survive whatever threat we're confronting. Click To Tweet
We ended up talking about this as a set of core beliefs that we have about the world we live in, our own futures, and the kind of people we are. These beliefs, when they’re challenged by certain kinds of events, that’s our definition of trauma. Challenges to these beliefs are what make for trauma. They need to be reconstructed. We’ve got to come up with a new version of a belief system that allows us to navigate the world more successfully and therefore reduce our anxiety.
Without that reconstruction, we’re left anxious. We don’t know which way to turn. It’s like a map that doesn’t work. We got to reconstruct it into something that makes sense of what happened to us and also allows us to go forward with a sense of confidence that we know ourselves, our world, and what might happen next. We’re good predictors of what’s going to happen rather than being shocked by things.
Would you say there’s a timeline for that? Does this vary from person to person, trauma to trauma? Obviously, trauma is an individual experience.
It is an individual experience, so some people develop the reconstructed core belief system relatively soon. Other people take years.
I mentioned resilience before. I start to read online reading with regard to trauma. Sometimes the word resilience comes up. It seems like it’s oftentimes conflated with post-traumatic growth. I’m wondering if we talk first about what resilience is and how that relates to post-traumatic growth, the question that we might lead to, and maybe you can answer this early, is there an interdependent nature between resilience and post-traumatic growth?
Here’s the relationship. People who are resilient have the ability to withstand stresses and difficulties successfully without failing or developing symptoms. They bounce back quickly or they’re relatively unaffected by things. Those people, in a way, don’t need to experience growth because their core belief system when something is not working well is they say, “I get it. I understand what’s going on. I can handle this and whatnot.” Resilient people are operating like that.
Post-traumatic growth has a different trajectory altogether. We talked about the Shattered Assumptions. It’s a shattering experience. People are made acutely anxious. They’re confused. It’s a real negative experience and response to this event or a set of events that people go through. That is completely different from the resilience that we talked about.
What happens as a result of this shattering of the assumptive world or core belief systems is people have to reconstruct. In the reconstruction, they develop a way of being and way of living that goes beyond who they were before and what they did before. They’re not just at baseline like the resilient person is. They go above baseline into a transformative state. It’s something that’s different from what they were before. They’re essentially transformed into a different version of themselves. It’s a difficult and unpleasant process that most people are going through to get there.
Post-traumatic growth is not just finding your happy place or something. It’s a challenging experience. People are struggling through this. In fact, we emphasize the word struggle. The resilient person doesn’t have to struggle. The person who eventually develops post-traumatic growth has struggled a lot. They’re trying to figure out, “Who I am? What kind of world do I live in? Who can I trust or count on? What’s going to happen next? What can I control? How safe am I?” All kinds of questions like that. Those are the core beliefs. They’ve struggled through all that to construct a version of themselves, their lives, and their reality that makes better sense so they’ve come out wiser.
Resilience is bouncing back from the experience to pretty much exactly where you were, while post-traumatic growth is something new that comes out of the experience and the reconstruction of what that experience means to your life.
As a result of that reconstruction, hopefully, in the past, you’re better equipped to handle life better. You have a better cognitive map. You understand life. You understand yourself. In response to events that come on upon you down the road, you’re going to be resilient because now you have a system of operating that allows you to manage things more successfully. We can say that post-traumatic growth ultimately becomes a path towards more resilience for people.
That resonates well with especially people who’ve recovered from pain because there are aspects of that in there. We know that not everyone who goes through a traumatic experience suffers from symptoms necessarily. Is it safe to say that resilience-building interventions in early life will lead to less PTSD?It's not what's wrong with you; it's what happened to you. Click To Tweet
That’s certainly the hope. It’s hard to predict how this will all grow because you can have supposedly resilience-building interventions, but an individual person may confront experience or a set of experiences in life that still create a great deal of disruption for them. You might think you’re building resilience but you still find yourself challenged, and maybe experience post-traumatic growth because you go beyond again that previous level of functioning.
I want to talk about the five components of post-traumatic growth. Before I do that, it’s wise maybe that we pause because I noticed there’s an excitement almost building in our society around the concept of post-traumatic growth. Some practitioners may move toward this too early. What are the pitfalls of hearing this concept of post-traumatic growth and starting to talk to a patient about this before they maybe move through the other processes? Maybe you can talk to that for a moment.
Timing is important. First of all, it’s important for practitioners who want to use this concept to understand that there are struggles involved. You can’t just expect people to easily make these changes. That’s one thing. The second thing is that struggle involves collaborative work with the person who has experienced these difficulties in life. Sometimes it takes a long time. People often in the early phases of their experience aren’t ready to hear about growth. It sounds impossible or Pollyannish and foolish.
For example, I worked for many years with a nonprofit organization that served bereaved parents. That organization was one where we got to see post-traumatic growth all the time. We got to be with these parents when they went through all kinds of struggles to get there, but there’s no way that a person whose child has died would early on be able to say that something good is going to happen to this. There are a few exceptions that I saw, but generally not.
The other thing about this is the changes aren’t due to the trauma. That’s the important thing. They’re not due to the event. It’s in the aftermath of the event that these changes occur. We can’t say that a child’s death is a good thing that led to growth. No, it’s not. What led to growth is whatever happened in the aftermath of that death, what the parents did with that, what support they had, and all the rest. It’s the aftermath that we’re looking at. These are some things that some practitioners may not be aware of. That’s unfortunate because then this concept becomes something that looks pretty silly.
It’s giving people time. It’s a process through some of the things you’ve mentioned previously in this episode. I would imagine you’re waiting for the person to bring up their own experiences of them noticing that there might be something positive coming out of this experience rather than just the symptoms.
Yes, but sometimes they don’t even notice themselves first. You have to help point them out. This requires a good deal of clinical skill to encourage people in this direction without, on the other hand, making them feel like their failures and the inability to handle their difficult situations in life. When I try to help train people in this, it’s not a mechanical process. A lot of therapies have ended up being these step-by-step mechanical processes. This is not that. Healing from trauma is not a simple matter. I know there are therapies out there that purport to do that, but if we’re going to move beyond symptom reduction and more towards growth, it’s more complicated than that.
It’s a good point. We’re not going to package this into 8 to 12 sessions of whatever cognitive behavioral intervention and expect that post-traumatic growth is going to happen after that period.
There are wide interpersonal differences in how people respond to this. You have to be ready for those.
Let’s talk about the five components of post-traumatic growth. I know that you have the post-traumatic growth inventory. Go in through those five that you think will help eliminate what happens through this process.
I want to point out that these five components of post-traumatic growth were derived from research. They weren’t things that I or my colleague, Lawrence Calhoun, or anybody else just thought off. This came out of some first qualitative research we did where we interviewed people who had gone through different kinds of traumatic events. We transcribe these interviews. We took out of them some of these statements that ended up being part of this inventory. We subjected these to statistical analysis like factor analysis and whatnot. These five elements are derived from all of that work. Our concept is the concept of trauma survivors that comes through.
One element is personal strength. People sometimes say that as a result of going through what they went through, they’re stronger than they were before or they thought they were. A second element is changed interpersonal relationships, where they feel closer to other people, more compassionate or more empathic. They are better connected with other people more often because they’ve had good support and they’ve been able to disclose about themselves, and then get closer to people as a result of that. They often have more compassion for other trauma survivors given what they went through. They know what it’s like to be in pain and they understand other people in pain.Resilient people have the ability to withstand stresses and difficulties successfully without failing or developing symptoms. They bounce back quickly or are relatively unaffected by things. Click To Tweet
There’s that one, and then there’s a greater appreciation of life. This is the gratitude dimension for the most part, especially for things that were maybe once taken for granted. I’m sure in your work, you see how it’s easy to take for granted all kinds of physical capabilities we have until we start losing them. It’s easy to take for granted not being in pain, and then when you’re in pain, you wish for relief so much. It’s a gratitude dimension, especially for things that are pretty basic.
We then have new possibilities where people are often, out of necessity, confronted with having to change their life priorities or trajectories and interests, and develop new ways of living life or new priorities that they might not have pursued before. The last domain is spiritual and existential growth where people confront some questions about living a life that they might not have tackled before like what their purpose in life might be, what it means to be a human being, and what it means to be connected with other people, what it means to live and die, how to confront death, and all these sorts of spiritual and existential issues that we can skip over when we’re living an ordinary life and things are going according to plan.
How do you recommend the professionals use that post-traumatic growth inventory? Is it primarily something that you’re using for research or do you recommend professionals can use it as a pre-post-test measure?
It was developed for research, but it can be used for therapeutic purposes where you can ask people these questions and get them talking about some of these things. For example, my colleague at Boulder Crest, Brett Moore, and I wrote The Post-Traumatic Growth Workbook. In this workbook, we have the post-traumatic growth inventory along with other measures we developed primarily for research purposes. You can use them in therapeutic encounters too to get people thinking about things. Often, I don’t use them at all in that form, but I know what the questions are. I weave them into a conversation and make it more conversational. That’s another thing to do. When you become familiar with these instruments, then you can be conversational about it.
You mentioned Boulder Crest a couple of times. I know a lot of the work that you’ve done lives in that organization. I want to mention the URL now so we can check it out. They can go to BoulderCrest.org and learn about Richard’s work as well as his colleagues, and a program there called Warrior PATH. Can you tell us about Boulder Crest and its mission?
Boulder Crest was developed by a man named Ken Falke, who is a Navy veteran. He had a piece of property in the Blue Ridge Mountains of Virginia. After he retired from the Navy, he would go into DC, which is about an hour away and visit with wounded Navy personnel. He was an explosive ordinance disposal expert. He would bring them out to his place for a little RNR on a weekend or so. He and his wife decided that wasn’t enough and they wanted to develop something that would serve them more.
They cut off a piece of their property and built this retreat center. He is a great fundraiser for this. All our programs are free for anybody who wants to come. When I first met Ken, we talked about what the program should look like and decided that post-traumatic growth was the basis for what he had in mind, as well as what I was doing. That’s the basis for the programs. They’re meant for veterans. First of all, it was developed for veterans, but we also serve first responders like police, firefighters and EMTs in our programs as well.
They are delivered not only in Virginia where we are now, but we have a ranch in Arizona where we also deliver these programs and a number of other places around the country. We have partner programs where we train staff and use their facilities for the Warrior PATH program. That program is a week-long program where people stay in these beautiful locations and engage in a lot of outdoor and physical activities, as well as some training in how to manage their psychological difficulties. They’re in personal relationships. It’s a program that focuses on mind, body and spiritual life.
We even talk about finances because that’s something that’s often created problems for people too in these different kinds of professions. It’s all focused on a future orientation towards growth with the idea that people who come out of these programs will find a way to be of service, and not just have symptom reduction but to grow towards being a better service to the people around them, whether that’s their families or their neighborhoods and communities, however broad that is defined.
We then follow up. This is another thing. We don’t catch and release. We don’t do that, have people for a week and send them away. We have a continual follow-up process that we do through an app that we’ve developed where they continue to connect with us. We have more lessons. They are able to talk to the people in their cohort and our staff. That goes on for at least 90 days. They can do that for a year and a half.
The other thing about the program is it’s all peer delivered. I don’t do this program. I helped develop it, train and evaluate, but it’s delivered by people who’ve been through the program, veterans and first responders who we select that we think we’re good guides for people. We help train and support them. That’s what makes it effective as well because they’re all talking the same language. They’ve been through the same kinds of things. That competence in the culture of being a first responder or being a veteran is important so that people can feel safe and open up and start to explore these kinds of issues that we’re talking about.
I wasn’t aware that it was completely peer-led. That’s an important component, especially for veterans and first responders that you’re seeing there.It's easy to take for granted not being in pain until you're in pain and wish for much relief. Click To Tweet
It’s important and builds trust right away.
The Warrior PATH sounds like it’s the key program at Boulder Crest. You mentioned there’s a physical component, a psychological component, and a spiritual component. With regard to the peer-led piece of it, what kind of training is involved for someone to become a peer leader for that program?
They have to go through the program first and then we integrate them into the program delivery where they observe other guides. We call them path guides. We then introduced them and train them up to little pieces of the program. They get to do those under our supervision and the supervision of the other guides. They gradually do more and more of this program. It’s a step-by-step learning process. It’s one where they have a lot of support from their peers because it’s a team-delivered thing. Usually, there’s a team of maybe five path guides or so delivering a program. Everybody helps each other. The whole thing is collaborative among the guides and the people coming to the program. There’s a lot of comraderies.
Do you have any plans for expanding or future plans for Boulder Crest?
Yes, we’re always doing that. That’s why we have about ten different places we’re offering in the program now. We’re also offering another program called the Struggle Well program. This is where we go to workplaces where first responders work to deliver a program like this based on the post-traumatic growth concept and bring it to them. We got firefighters and police officers and people like that meeting with us again in groups with people who are peers and delivering that program in a way where we integrate it with all sorts of different levels of their organization.
If we go to a police department or a fire department, the leaders and everybody else down the line are part of this program. It’s meant to change the culture of the organization so that we enhance their wellness, their ability to help each other, and have good and healthy relationships with their communities. That’s what we’re doing now. It’s heartening to see. You might be surprised at how well these men and women take this program and how much they see the value in it.
I live in New York City. From the experience of the 9/11 responders, I can see something like that being important for them and hopefully something that they would embrace. Richard, it has been great speaking with you. Our entire community thanks you for your work on post-traumatic growth and your work at Boulder Crest. Everyone can go to BoulderCrest.org and find out about the work there. In addition to that, let people know your final thoughts and where people can learn more about you.
If they want to get in touch with me through Boulder Crest, please do. I’m at Rich.Tedeschi@BoulderCrest.org. They can contact me directly if they wish. Boulder Crest has published a book called Transformed by Trauma: Stories of Posttraumatic Growth. That’s another book that people might be interested in. We’ve done interviews with people. Some of them come through our program, and some are family members. It’s all based on military connections, but the traumas they talk about are universal. We have these interviews that we use to illustrate a lot of the things we talked about here and the process of training that we use at Boulder Crest to help people move towards posttraumatic growth. That’s another resource that people might want to look at.
At the end of every episode, I ask you to share this information with your friends and colleagues on social media. I’m on Instagram. You can reach out to me at DrJoeTatta.com. I want to thank Richard for being with us. Stay tuned. We’ll see you next episode. Take care.
- Boulder Crest
- Shattered Assumptions
- The Post-Traumatic Growth Workbook
- Transformed by Trauma: Stories of Posttraumatic Growth
About Richard Tedeschi, Ph.D
Richard Tedeschi, Ph.D., is a licensed psychologist and Professor Emeritus at UNC Charlotte. He was on the core faculty for 42 years, and retired in June 2018. Dr. Tedeschi has published numerous articles and books on the concept of posttraumatic growth that he helped to develop. He serves as media consultant on trauma for the American Psychological Association and is a Fellow of the Division of Trauma Psychology and has provided presentations and training on trauma for the U.S. Army, and many professional organizations, clinics, and educational institutions.