posttraumatic growth: why do people grow from their trauma?

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Posttraumatic growth: why do peoplegrow from their trauma?Andreas Kastenmüller a , Tobias Greitemeyer b , Desiree Epp c ,Dieter Frey c & Peter Fischer da Department of Natural Sciences and Psychology , Liverpool JohnMoores University , Tom Reilly Building, Byrom Street, Liverpool ,L3 3AF , UKb Department of Psychology , University of Innsbruck , Innsbruck ,Austriac Department of Psychology , University of Munich , Munich ,Germanyd Department of Psychology , University of Graz , Graz , AustriaPublished online: 18 Apr 2011.

To cite this article: Andreas Kastenmüller , Tobias Greitemeyer , Desiree Epp , Dieter Frey & PeterFischer (2012) Posttraumatic growth: why do people grow from their trauma?, Anxiety, Stress, &Coping: An International Journal, 25:5, 477-489, DOI: 10.1080/10615806.2011.571770

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Posttraumatic growth: why do people grow from their trauma?

Andreas Kastenmullera*, Tobias Greitemeyerb, Desiree Eppc, Dieter Freyc and

Peter Fischerd

aDepartment of Natural Sciences and Psychology, Liverpool John Moores University, Tom ReillyBuilding, Byrom Street, Liverpool L3 3AF, UK; bDepartment of Psychology, University ofInnsbruck, Innsbruck, Austria; cDepartment of Psychology, University of Munich, Munich,

Germany; dDepartment of Psychology, University of Graz, Graz, Austria

(Received 16 January 2011; final version received 8 March 2011)

In two experimental studies we found that participants who recalled a highlytraumatic autobiographical event (trauma recall) compared with a lessertraumatic event (stress recall) reported having increasingly grown (posttraumaticgrowth, PTG). Moreover, participants who recalled a traumatic (vs. stressful)event perceived more death-related thoughts (Study 1) and reported coping withthis event in a more emotion-focused and in a less problem-focused way (Study 2).Mediation analyzes revealed that the effect of trauma versus stress recall on PTGwas mediated by emphasizing the positive, a subscale of emotion-focused coping.These results imply that growth resulting from traumatic events can be tracedback to an illusion. No evidence was found that real PTG took place or that theeffects shown resulted from death-related thoughts (terror management theory).

Keywords: trauma; stress; posttraumatic growth

A traumatic event such as the diagnosis of a serious illness or the loss of a loved one

is shocking and unfortunately inevitable for most of us (Davis & McKearney, 2003).

As these events are highly threatening for humans, they often cannot continue with

their previous lifestyle and thus have to reconstruct and reorganize their life (e.g.,

Janoff-Bulman, 1992). Although traumatic events are painful, many people consider

them as a challenge and report that they are not only accompanied by negative

effects but also by positive outcomes. In this context, many people stated that they

have grown psychologically from traumatic events; for example, they considered their

lives more meaningful, appreciated their lives more, became closer to their friends

and family, and obtained greater fulfillment from their religious faith (e.g., Sumalla,

Ocha, & Blanco, 2009). These positive effects of traumatic events are called

posttraumatic growth (PTG) and are very common, as a large body of field studies

suggests (for reviews, see Sumalla et al., 2009; Zoellner & Maercker, 2006).

Why do people grow from traumatic events? In this context, various researchers

cite different reasons for the occurrence of PTG (for a review, see Sumalla et al., 2009).

At least three different theoretical approaches are currently under discussion (e.g.,

Sumalla et al., 2009). In the first approach, PTG is considered as a positive change

(PTG as a reality), which is caused by a problem-focused coping process (e.g.,

*Corresponding author. Email: [email protected]

Anxiety, Stress, & Coping

Vol. 25, No. 5, September 2012, 477�489

ISSN 1061-5806 print/1477-2205 online

# 2012 Taylor & Francis

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Tedeschi, Park, & Calhoun, 1998). In the second approach, PTG is assumed to be an

illusion and is caused by emotion-focused coping processes. Whereas most researchers

state that PTG can be either an illusion, a reality, or both (Sumalla et al., 2009), in the

third approach, Davis and McKearney (2003) argue from terror management theory(TMT, Greenberg, Simon, Pyszczynski, Solomon, & Chatel, 1992; Pyszczynski &

Kesebir, 2011) that traumatic events cause existential anxiety (i.e., death-related

thoughts), which in turn increases people’s PTG. So far, however, a stringent test of

these approaches is still lacking. First, most of the previous studies were based on

correlational designs, which do not entertain cause and effect relationships. Second,

the mediating psychological mechanism has not been clearly identified. In the present

research, we investigate the impact of traumatic events on PTG experimentally and

test the role of three different psychological variables (i.e., problem-focused coping,emotion-focused coping, and death-related thoughts) as mediators.

Previous research on PTG

The word ‘‘trauma’’ primarily describes the damage or injury that is caused by

experiencing and/or witnessing threatening events such as abuse (sexual, physical,

and emotional), war, illness, drug addiction, loss of a loved one, and disaster (e.g.,

natural disasters, terrorism). These negative events are often accompanied by

negative effects that have been categorized in diagnosis manuals and are referred toas posttraumatic stress disorder (PTSD; e.g., Joseph & Linley, 2006; Sumalla

et al., 2009). Traumas are often linked with negative outcomes (i.e., posttraumatic

stress disorder or PTSD), but can also be accompanied by positive aspects, that is,

PTG, whereby a person undergoes a change in their personal development that

extends beyond their previous functional level (Vazquez, Hervas, & Ho, 2007).

It should be noted that the word ‘‘posttraumatic’’ implies that growth is caused by

an extreme event and is not initiated by other minor stressors, and is not part of a

natural process of personal development (Zoellner & Maercker, 2006). Tedeschi andCalhoun (1995) emphasize in this context that PTG is not caused by the event itself but

results from the struggle with it. Perez-Sales (2006) also states that PTG refers to a

reorganization of people’s basic beliefs and main assumptions in terms of the way they

perceive the world, their identity as individuals, and the relationship with other people

(Janoff-Bulman, 1992). Tedeschi, Park, and Calhoun (1998) mention three different

positive change categories. The first category refers to positive changes of the self; that

is, people report feeling stronger, more self-assured, more experienced, and more

capable of coping with future changes. The second category refers to changes ininterpersonal relationships such as becoming closer to family members and friends and

an increased need to express one’s feelings and emotions to others. The third category

refers to changes in spirituality and life philosophy; for example, people report that

they appreciate what they have to a greater extent, they recognize what matters to them

and what matters less, and their religious faith becomes more important.

As regards the question why people grow from their trauma at least three

different theoretical approaches have been developed (e.g., Zoellner & Maerker,

2006). In all of them events are considered as loss of coherence, perceived control,and self-esteem. The main difference in the three approaches is how people deal with

these losses and damages, which in turn eventually lead to PTG. In the first

approach, PTG is described as a long-term voluntary accommodation process and is

often called PTG as reality. In the second approach, PTG is considered as a

478 A. Kastenmuller et al.

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short-term unintentional assimilation process and is often labeled PTG as illusion

(Sumalla et al., 2009). The third approach is similar to the illusion approach but

emphasizes the importance of death-related thoughts (Davis & McKearney, 2003). In

the following we describe these three approaches.

Growth as a problem-focused coping process: PTG as reality

In this approach, PTG is highlighted as a long-lasting process, which results in a

positive fundamental change of one’s identity. Brewin (2003) points out that, in some

cases, the traumatic event even becomes a phenomenon central to one’s identity. In

this context, PTG is assumed to be a constructive component which is strengthened

over time, the process being more accommodative than assimilative. Schaefer and

Moss (1998) additionally point out that after a traumatic event, important schemashave to be changed, and in the process they accommodate the novel information

referring to the event (Tedeschi & Calhoun, 1995). Tedeschi et al. (1998) reported

that the person initiates a ruminative and automatic process, whereby she/he re-

experiences the trauma. This rumination activity often leads to a reconstruction of

basic schemas. It starts unintentionally, but after a certain period of time it is guided

and willed, as people try to make sense of the negative experience. If the person

manages to construct new structures, she/he may take one step forward to the next

adaptation level. If the person fails to generate these structures, she/he is likely todevelop despair and pessimism (see also Sumalla et al., 2009).

Growth as an emotion-focused coping process: PTG as an illusion

In this theoretical approach PTG is considered as an unintentional change where

growth is the unexpected result of an assimilation process. In contrast to the

approach mentioned earlier (PTG as reality), PTG is seen as an illusion aiming to

reduce the negative emotions resulting from the extreme event. As traumatic

experiences are accompanied with loss of self-esteem, coherence, and perceivedcontrol, people use PTG cognitively to avoid these losses. Thus, the illusion approach

suggests that PTG is a short-term palliative coping strategy (Wagner, Forstmeier, &

Maercker, 2007). Consequently, the extreme experience is assimilated within the

preexisting schemas that people maintain in terms of the self, others, and the world

(Schaefer & Moos, 1998; Tedeschi & Calhoun, 1995). In other words, authors who

emphasize the illusory component of PTG point to its functional nature whereby

people try to protect their self-esteem and perceived control. Likewise, Taylor and

Armor (1996) argue in their cognitive adaptation theory that self-reported growthreflects a self-enhancement strategy. This self-enhancement can be achieved by

different cognitive illusions involving selective interpretations and comparisons. As a

consequence, PTG is possibly a distorted interpretation of how a person is changed

by a loss or a trauma (e.g., Davis & McKearney, 2003).

Growth as a result of death-related thoughts: a TMT approach

In this approach, PTG is interpreted within the TMT framework. TMT (Greenberg,

Solomon, & Pyszczynski, 1997; Pyszczynski, Greenberg, & Solomon, 1997) suggeststhat statements of growth may stem from thinking about mortality. As traumatic

events are often accompanied by death (e.g., cancer, loss of a loved one) this

argument seems to be a reasonable one. TMT suggests that humans are the only

animals who recognize that they will die one day and this potentially leads to

Anxiety, Stress, & Coping 479

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existential terror/anxiety. In order to reduce this existential terror of mortality

salience people try to defend their worldview (Davis & McKearney, 2003). A cultural

worldview is akin to the assumptive worldviews described by Janoff-Bulman (1989,

1992), and represents a collection of beliefs that give meaning to one’s everydayexistence. As life-meaningfulness is an important component of PTG, one can

assume that trauma increases PTG because traumas are often linked with death-

related thoughts. In fact, Davis and McKearney (2003) found that people who were

reminded of a trauma or their own death reported higher life-meaningfulness than

people who were reminded about drinking water (controls). Thus, the authors argue

that traumas are accompanied by PTG because they lead to existential anxiety.

To sum up, previous research showed that traumatic events can be followed by

PTG. They differ, however, in terms of why PTG occurs (e.g., Sumalla et al., 2009).So far, previous research has focused on one explanation but has neglected the other

two approaches. That is, a true test that pits off the different psychological

mechanisms is still missing. This is the aim of the present research.

The present research

In the present investigation, we want to test with experimental designs whether theawareness of an extreme event (compared with a less extreme event) causally leads to

increases in the different facets of PTG. Moreover, we wanted to shed more light on

why PTG occurs. Three possible psychological mechanisms were taken into account:

death-related thoughts (TMT approach), problem-focused coping (PTG as reality),

and emotion-focused coping (PTG as an illusion). Therefore, we conducted two

studies in which participants were asked to recall an autobiographical extreme event

(trauma recall) versus moderate event (stress recall). In both studies, we expected

that trauma (vs. stress) recall would lead to increases in PTG. As possible mediatingvariables we additionally measured death-related thoughts (Study 1), problem-

focused coping and emotion-focused coping (Study 2). Finally, we measured positive

and negative emotions as possible alternative mediators.

Study 1

Method

Participants and design

Sixty-six employees participated in this study (33 women, 33 men, age: M�36.59,

SD �13.31). Participants were randomly assigned to one of two experimental

conditions (event: trauma vs. stress).

Procedure and materials

Participants were friends and relatives of the experimenter. All of them wereemployees and held various positions such as nurses, professors, architects, social

workers, artists, engineers, businessmen, and administrator. The experimenter asked

whether they would like to participate in a psychological and possibly distressing

experiment. If they agreed, the experimenter met them individually in their home, the

experimenter’s home, a cafe, or the university, and gave them a questionnaire. They


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were told that the study was anonymous and that they could withdraw from the

experiment at any time. At the beginning participants were asked to write up an

autobiographical event that was highly stressful, that is, traumatic (e.g., loss of a loved

person, serious illness) or much less stressful (e.g., time pressure, high workload).Afterwards they were presented with the positive and negative affect scale (PANAS,

Watson, Clark, & Tellegen, 1988) with the subscales of positive affect (a�.83) and

negative affect (a�.86) (from 1 [not at all] to 5 [totally]). Next, we presented a word

fragment completion measure that was designed to assess the accessibility of death-

related thoughts (see e.g., Jonas & Fischer, 2006). In this context, 21 word fragments

were shown, of which six could be completed as death-related words (e.g. GRA_ to

GRAB [German word for grave]) or neutral words (e.g., GRAS [German word for

grass]). Next, we presented the Posttraumatic Growth Inventory (PTGI, Tedeschi &Calhoun, 1996; German version by Maercker & Langner, 2001) (from 0 [not at all] to

6 [totally]), which consists of the following subscales: personal strength (4 items,

a�.62); spiritual change (2 items, a�.77); relating to others (7 items, a�.83);

appreciation of life (3 items, a�.60); and new possibilities (5 items, a�.79).

Additionally, all PTG items were matched to an overall PTG scale (a�.89). Finally,

participants were debriefed and thanked for their participation.

Results

For means and standard deviations see Table 1.

Death-related thoughts

Participants in the trauma condition had more death-related thoughts than

participants in the stress condition, F(1, 64) �6.69, p�.01. Checks for interfering

effects where the variables sex, age and positive and negative emotions were used as

covariates within an ANCOVA revealed that these covariates had no significant

effect on the impact of trauma vs. stress on death-related thoughts, all ps�.28.

Table 1. Means and standard deviations in Study 1.

Experimental condition

Stress Trauma

N�31 N�35

Dependent measures M SD M SD

Positive affect 2.99 0.49 2.75 0.71

Negative affect 1.46 1.25 1.78 1.42

Death-related thoughts 0.16 0.18 0.30 0.26

1. new possibilities 3.14 0.86 3.28 0.93

2. relating to others 3.16 0.87 3.57 0.75

3. appreciation of life 3.23 0.99 3.76 0.81

4. personal strength 3.48 0.57 3.71 0.79

5. spiritual change 2.06 1.06 2.80 1.31

PTG overall 3.12 0.66 3.48 0.72


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Posttraumatic growth (PTG)

Participants in the trauma condition had higher ratings in the PTG overall scale

compared with participants in the stress condition, F(1, 64) �4.50, p�.04. Separate

analyzes for the different subscales showed that participants who were asked to

describe a traumatic event (compared with a stressful event) had higher ratings in the

subscales relating to others (F[1, 64] �4.37, p�.04), appreciation of life

(F[1, 64] �5.82, p�.02), and spiritual change (F[1, 64] �6.19, p�.02). In termsof the subscales personal strength (F[1, 64] �1.85, p�.17) and new possibilities

(FB1) no significant differences emerged. Checks for interfering effects where the

variables sex, age and positive and negative emotions were used as covariates within

an ANCOVA revealed that these covariates had no significant effect on the impact of

trauma versus stress on PTG, all ps�.14.

Mediation analyzes

Correlation analyzes indicated that neither the overall PTG-scale nor the PTG-

subscales significantly correlated with death-related thoughts, all rsB.18, all ps�.16.

Thus, we found no evidence that death-related thoughts mediated the impact oftrauma on PTG.

Emotions

Our analyzes revealed no significant differences between the conditions in terms of

positive emotion (F[1, 64] �2.25, p�.11) and negative emotion (F[1, 63] �1.18,

p�.28).

Discussion

As predicted, we found that people in the trauma condition reported having grown to

a greater extent than participants in the stress condition. Interestingly, we showed that

people in trauma condition (vs. controls) had more death-related thoughts. Thisshows that our recall manipulation is an appropriate manipulation for varying

mortality salience and death-related thoughts, respectively. We found no evidence,

however, that death-related thoughts mediate the effect of our trauma-manipulation

on PTG. Thus, no evidence was provided that TMT (Greenberg et al., 1992) is an

appropriate theoretical framework for the interpretation of our results. Note that the

applied trauma-manipulation had no effect on affect, suggesting that affect is no

alternative mediator as well. This is consistent with the outcomes of classical mortality

salience manipulations where people are asked to write down the first sentence thatcomes to their mind when they think about their own death (vs. dental pain) and which

do not have a significant impact on affect (e.g., Greenberg et al., 1992).

Study 2

In the next study, we used the same trauma manipulation as in Study 2. Moreover,

we employed a manipulation check to test whether the manipulation had the desired


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effect. Additionally, we measured problem-focused and emotion-focused coping in

order to test their role as potential mediators.

Method

Participants and design

Forty employees (19 men, 19 women, 2 did not state their sex, age: M�37.78,

SD �12.47) participated in this study. Participants were randomly assigned to one of

two experimental conditions (event: trauma vs. stress).

Procedure and materials

Participants were recruited after a workshop in a German company. Participants were

asked whether they would like to fill in the questionnaire at home and bring it back the

next day. The procedure was similar to Study 1. At the beginning participants were asked

to write up an autobiographical stressful or traumatic event. As a manipulation check, we

asked them how traumatic and how stressful this event was (from 0 [not at all] to 10

[totally]). Next, we measured the Ways of Coping inventory (Folkman & Lazarus, 1980)

which measures emotion-focused and problem-focused coping. Emotion-focused coping

includes the subscales wishful thinking (6 items, e.g., ‘‘I tried to show my feelings

somehow.’’), distancing (6 items, e.g., ‘‘I carried on as if nothing has happened.’’), self-

isolation (7 items, e.g., ‘‘I tried to keep my feelings with me.’’), seeking social support (6

items, e.g., ‘‘I was looking for professional help.’’), blame self (4 items, e.g., I criticized

myself.’’), tension reduction (8 items, e.g., ‘‘I hoped for a miracle’’), and emphasizing the

positive (7 items, e.g., I discovered the important things in life in a new way). All these

items were combined to the overall emotion-focused coping scale, a�.92. Problem-

focused coping was measured with six items (e.g., ‘‘I focused on things that I had to do

next.’’,a�.77). Afterwards, we measured the PTG-inventory with the subscales: personal

strength (4 items, a�.60); spiritual change (2 items, a�.95); relating to others (7 items,

a�.84); appreciation of life (3 items, a�.63); and new possibilities (5 items, a�.79).

Additionally, all PTG-items were matched to an overall PTG-scale (a�.85). Finally, after

participants returned, they were debriefed and thanked for their participation.

Results

For means and standard deviations see Table 2 and Figure 1.

Manipulation check

Participants in the trauma group reported that the event they described was more

traumatic than that reported by participants in the stress group, F(1, 38) �21.98,

pB.05. On the other hand, participants in the stress group reported that the event

they described was more stressful than that described by participants in the trauma

group, F(1, 38) �4.65, pB.05.


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Ways of Coping (WOC)

Our data showed that people in the trauma group used more emotion-focused

coping styles compared with people in the stress group, F(1, 38) �4.25, pB.05.

Further analyzes for the referring subscales revealed that a traumatic event

(compared with a stressful event) led to increased distancing (F[1, 38] �5.87,

pB.05), tension reduction (F[1, 38] �8.32, pB.05), and emphasizing the positive

Table 2. Means and standard deviations in Study 2.

Experimental condition

Stress Trauma

N�18 N�22

Dependent measures M SD M SD

Perceived trauma 4.06 2.34 7.39 2.15

Perceived stress 8.33 1.08 6.86 2.71

Positive affect 2.76 0.66 2.90 0.52

Negative affect 1.48 0.52 1.63 0.54

Wishful thinking 1.95 0.41 2.02 0.52

Distancing 1.60 0.32 1.82 0.27

Self-isolation 2.03 0.57 2.19 0.53

Seeking social support 2.35 0.73 2.73 0.74

Blame self 2.01 0.73 1.84 0.77

Tension reduction 1.49 0.42 1.94 0.53

Emphasizing the positive 2.01 0.57 2.59 0.68

Emotion-focused coping (overall) 1.92 0.36 2.16 0.37

Problem-focused coping 2.74 0.70 2.17 0.62

1. new possibilities 1.81 0.63 1.92 0.59

2. relating to others 1.71 0.54 2.19 0.38

3. appreciation of life 1.80 0.55 2.18 0.52

4. personal strength 2.04 0.46 2.11 0.49

5. spiritual change 1.22 0.52 1.76 0.91

PTG overall 1.76 0.44 2.07 0.41

* p < .05; ** p < .01

trauma(yes vs. no) PTG

Emotion-focusedcoping

(emphasizing thepositive)β = .42**

β = .34*

(β = .07 n.s.)

β = .66**

Figure 1. The effect of trauma on PTG and the role of emotion-focused coping as a mediator

(Study 2). *pB.05; **pB.01.


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(F[1, 38] �8.25, pB.05). For the remaining subscales no significant differences

emerged, all ps�.11. Moreover, our data revealed that participants in the trauma

group used a less problem-focused coping style than participants in the stress group,

F(1, 38) �7.37, pB.05. As PTG significantly correlated with emotion-focused

coping (r�.63, pB.05) and not with problem-focused coping (r�.09, p�.56),

emotion-focused coping and not problem-focused coping has been identified as a

potential mediator. Checks for interfering effects where the variables sex, age, and

positive and negative emotions were used as covariates within an ANCOVA revealed

that these covariates had no significant effect on the impact of trauma vs. stress on

WOC, all ps�.08.

Posttraumatic growth (PTG)

Our data showed that people in the trauma group reported more PTG (overall

scale) compared with people in the stress group, F(1, 38) �4.94, pB.05. Separate

analyzes for the different subscales showed that participants who were asked to

describe a traumatic event (compared with a stressful event) had higher rates in the

subscales relating to others (F[1, 38] �10.45, pB.05), appreciation of life (F[1,

38] �5.15, pB.05), and spiritual change (F[1, 38] �4.99, pB.05). In terms of the

subscales personal and new possibilities, no significant differences emerged, FB1.

Checks for interfering effects where the variables sex, age and positive and negative

emotions were used as covariates within an ANCOVA revealed that these

covariates had no significant effect on the impact of trauma vs. stress on PTG,

all ps�.06.

Mediation analyzes

To test whether and which of the seven emotion-focused coping subscales (i.e.,

wishful thinking, distancing, self-isolation, seeking social support, blame self, tension

reduction, emphasizing the positive) mediate the effect of trauma on PTG, a multiple

mediator bootstrapping analysis based on 1000 bootstraps was executed (Preacher &

Hayes, 2008). Results showed a significant direct effect of the independent variable

on PTG, t�2.22, pB.05, which was reduced to non-significance, t�.77, p�.45

when we controlled for the seven mediators (emotion-focused coping). Further

analyzes showed that the true indirect effect for the subscale emphasizing the positive

was estimated to lie between .0243 and .3922 with 95% confidence. Because zero is

not in the 95% confidence interval, one can conclude that the real indirect effect

became significant at pB.05 (two-tailed). In terms of the remaining six subscales

zero was in the 95% interval and as a consequence no evidence could be found that

these variables mediated our effects. Thus, it appears that the variable emphasizing

the positive mediates the effect of trauma on PTG.

Emotions

Our analyzes showed no significant differences in terms of positive and negative

emotions, all Fs B1.


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Discussion

Study 2 showed � consistently with Study 1 � that people who wrote about a

traumatic (vs. stressful) autobiographical event reported to have grown to a greater

extent and that this manipulation had no significant impact on affect. Interestingly,

trauma recall compared with stress-recall decreased problem-focused coping and

increased emotion-focused coping, where the subscale emphasizing the positive (a

subscale of emotion-focused coping) mediated the effect on PTG. This supports the

notion that PTG is an illusion rather than a reality.

General discussion

The present research investigated whether and why traumatic autobiographical

events lead to PTG. Three different theoretical approaches were taken into account,

that is, the TMT approach, the PTG as reality approach and the PTG as illusion

approach. In line with our predictions, in two studies we showed that participants

who were asked to describe a traumatic event (vs. stressful event) reported increased

PTG. Additionally, it was found that participants in the trauma condition had more

death-related thoughts (Study 1). Moreover, these participants reported to have used

more emotion-focused and less problem-focused coping strategies (Study 2).

Mediation analyzes indicated that emphasizing the positive, a subscale of emotion-

focused coping mediated the effect of the described event (trauma vs. stress) on PTG.

Thus, our results provided evidence for the PTG as an illusion approach but not for

the TMT and the PTG as a reality approach.

As mentioned earlier, the present article represents the first research showing that

a highly traumatic event leads to increased PTG and using an experimental design

which allows cause and effect interpretations. Davis and McKearney (2003) showed

that recalling a highly traumatic event can cause PTG, but they used a different

manipulation. Whereas we asked participants to write down a highly or a less

traumatic event, Davis and McKearney (2003) asked individuals to write down a

highly traumatic event versus a non-traumatic event (i.e., drinking water). Thus,

according to Davis and McKearney’s data it remained unclear whether a highly

traumatic event causes more PTG compared with a less traumatic event. The present

investigation addressed this shortcoming. It should be noted, however, that we do

not know whether a less traumatic event can lead to PTG compared with a non-

traumatic event. However, in this context, Sumalla et al. (2006) state that the

development PTG requires a severely stressful event. Thus, one can provide that

people who experienced a slightly stressful event do not necessarily grow more from

it compared with people who experienced no stressful event. To clarify this, future

research should ask individuals to recall a highly traumatic event versus a less

traumatic event versus a non-traumatic event. We would assume that PTG is

relatively low in the low trauma and the no trauma condition and relatively high in

the high trauma condition.

At first sight it is surprising that we did not find any significant differences in

emotions between the two experimental conditions. One possible explanation for this

result is that participants experienced the highly (vs. less) traumatic event some time

ago and that recall of these events is no longer accompanied by negative emotions.

Moreover, previous research varying mortality salience (e.g., Greenberg et al., 1992)


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also found no differences in emotions. As our trauma manipulation had an effect on

death-related thoughts (like mortality salience manipulations), this non-finding

seems to be reasonable.

It is worthwhile noting that trauma-recall compared to stress-recall wasaccompanied with less problem-focused but with more emotion-focused coping.

This result possibly occurred, because traumatic events are less controllable than

stressful events. For example, many traumatic events like terror attacks or the death of

a loved person cannot be met with problem-focused coping, because they cannot be

undone. Stressful events such as time pressure, however, often can be resolved by extra

effort. Thus, it seems to be reasonable that stressful events are more likely to be met

with problem-focused coping and traumatic events with emotion-focused coping.

Our results have important implications for clinical practitioners, because the threetheoretical approaches imply different treatments for trauma patients. Given that PTG

could have been traced back to ‘‘real growth,’’ one would suggest, for example, that

therapists should help their patients to intensively re-experience the traumatic event in

order to foster ruminative processes and, thus, to create new structures (e.g., Sumalla

et al., 2009). Given that the TMT-approach would have been supported by our data,

one would possibly propose that therapists should work with death-related stimuli

with their patients in order to promote growth. Our research, however, suggests that

PTG resembles an illusion where affected people try to emphasize positive aspects ofthe referring traumatic event to overcome its negative effects. This implies that one

focus of trauma treatment should aim at giving patients the chance to retreat. This

could be achieved, for example, by encouraging patients to mentally recover at a

protected physical (e.g., a private place at home or in a hospital) or mental (imagined)

place for a certain period of time. Alternatively, patients could be asked to write down

their experiences on a piece of paper and to (symbolically) lock it up, for instance, in a

lockable box. Perhaps, extensive confrontation with traumatic events (prolonged

exposure therapy) does not have necessarily positive effects but possibly postpones thenegative effects of these events (i.e., PTSD, see e.g., Joseph & Gray, 2008).

Limitations

Note that trauma and PTG were considered from a retrospective perspective. Thus, it

remains unclear whether the participants remembered correctly the traumatic event

and how they coped with it. In addition, it should be noted that we do not know

whether our participants used the different WOC-coping-styles only for a certain

period of time after the traumatic or stressful event and changed it later. Possibly,

people who experienced a traumatic event coped in an emotion-focused way first and

later coped in a problem-focused way. Moreover, only small sample sizes were used.

Furthermore, we have to admit that we did not ask our participants when the criticalevent occurred. Given that highly traumatic events occur less often than stressful

(i.e., less traumatic) events we cannot identify to what extent the passage of time

influenced our results.

Conclusion

Previous research shows that traumas are not only accompanied by negative

consequences (e.g., PTSD) but also by positive outcomes (PTG). Sadly, the present


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data indicate that this PTG is often a palliative coping mechanism which does not

lead to long-term positive changes. We want to point out, however, that some

traumatic changes (e.g., loss of job) can lead to an improvement in one’s situation

(e.g., one finds a better job). Aspects like these, however, are not considered in the

present investigation.

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posttraumatic growth: why do people grow from their trauma?

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