Post-Traumatic Growth and Aging

Abstract:

Most older adults have experienced at least one traumatic event in their lifetime. This article explores the relationship between aging and post-traumatic growth (PTG). Increasingly, PTG is recognized as a phenomenon describing positive changes following an adverse or traumatic event. This article reviews a widely researched model of PTG in the context of aging and provides evidenced-based factors associated with PTG in older adulthood. Given the dynamic nature of PTG, it is never too late to experience positive psychological growth. While PTG holds promise, a nuanced approach is essential, respecting individual variations and growth trajectories.

Key Words:

post-traumatic growth, older adults, aging, trauma

By late life, nearly 90% of older adults will have suffered at least one traumatic event (Kuwert et al., 2013). The World Mental Health Consortium reports that a substantial number of people worldwide (30.5%) will endure four or more traumatic events during their lifetime (Benjet et al., 2015). Of these trauma-exposed individuals, a small but significant percentage (5.6%) will go on to develop post-traumatic stress disorder (PTSD; Koenen et al., 2017).

However, approximately 50% will go on to eventually experience some type of post-traumatic growth (PTG; Wu et al., 2019). This finding highlights the complex relationship between trauma symptoms and PTG. To better understand the process of PTG among older adults, it is useful to consider the interaction between trauma and aging.

Although a traumatic event can be a taxing stressor at any age, the intersection of aging and mental health in the context of a trauma event presents a particularly complex and pressing concern. As people advance through the life course, exposure to more small and large traumatic events becomes increasingly likely (Kuwert et al., 2013). The psychological consequences of these events can be long-lasting. Moreover, the presence of acute and chronic conditions that are more common in late life can amplify the effects of trauma. Physical and cognitive changes intersect with the psychological impact of trauma and foster additional challenges for older adults who are striving to maintain well-being (Lupien et al., 2009).

Additionally, the aging process can produce thoughts and emotions associated with past traumatic events that can lead to a resurgence of anxiety, depression, and PTSD symptoms (Davison et al., 2006). The probability of a resurgence of symptoms is increased during major life transitions, such as changes in health status, familial roles, retirement, or the death of a loved one.

Perceptions and coping styles in response to a traumatic stressor also are influenced by cultural background, beliefs, and values. What might be considered traumatic in one culture may not be equally important in another. Cultural competency is essential when working with older adults from diverse backgrounds in any setting. Social factors also play a significant role in shaping the well-being of older adults who have sustained trauma. The loss of or decrement to a social support network resulting from death, retirement, or relocation can leave an older adult isolated and more vulnerable to trauma’s harmful effects (Davison et al., 2006). Social isolation also can exacerbate a range of mental health issues, including depression and anxiety, which are common diagnoses for people with histories of trauma (Brandt et al., 2022).

When examining the effects of trauma on mental health, it is also essential to consider cultural and historical context. Many older adults have undergone traumatic stressors related to war, displacement, and discrimination. Additionally, chronic stressors, such as minority stress, have been shown to adversely affect mental health (Brandt et al., 2022). Collective trauma from pandemics and extreme weather events also can have lasting negative effects on functioning (Silver et al., 2020). However, those who have experienced significant distress following an adverse or traumatic event, as previously mentioned, may experience PTG (Tedeschi & Calhoun, 1996). PTG is a psychological occurrence observed when positive changes result after a traumatic stressor or challenging event (Tedeschi & Calhoun, 2004).

Defining and Differentiating Post-Traumatic Growth

Resilience and PTG are not the same concept. Resilience has been defined as the ability to maintain a stable equilibrium when facing adversity (Bonnano, 2004). Resilience also differs from recovery, a normal process in which functioning is temporarily impacted but slowly returns to baseline within a reasonable timeframe. It is essential to note that resilience does not imply the absence of pain, suffering, or distress. Resilient individuals often feel transient distress, but these events are typically short-lived and do not interfere with long-term functioning (Bonanno, 2004). This transient nature of distress, rather than its complete absence, differentiates resilience from other recovery trajectories. While resilience is another positive outcome following an adverse or traumatic event, it describes returning to baseline functioning rather than experiencing positive changes and growth.

Fundamentally, PTG is about positive change and is aligned with earlier research concerning the nature of positive outcomes following adversity (Linley & Joseph, 2004). Often, discomfort and stress stimulate growth. This idea can be seen across disciplines and in a wide range of contexts. In fields such as education, medicine, business, and others, the idea that challenges can foster growth is well-documented and has profound implications in education, technology (Henriksen et al., 2021), and medicine (Edmondson, 2004).

It is posited that as individuals navigate the aftermath of traumatic events, they often undergo a process of cognitive restructuring wherein they reevaluate their core beliefs, values, and priorities (Elam & Taku, 2022). A person who has survived a life-threatening illness may develop a heightened appreciation for the importance of family and friends. This cognitive shift can lead to an increased sense of purpose, greater emphasis on personal growth, and appreciation of life. Moreover, individuals may perceive an enhanced sense of self, which allows them to better cope with future stressors (Mann et al., 2004).

Tedeschi and Calhoun’s 1996 and 2004 models of PTG are widely accepted and researched. During the past 3 decades, their publications have been referenced more than 6,000 times. In their 1996 model, Tedeschi and Calhoun identified five distinct domains in which growth occurs:

1. Relating to others
2. New possibilities
3. Personal strength
4. Spiritual change
5. Appreciation of life

In the 2004 publication, Tedeschi and Calhoun elaborated on their conceptual framework and provided empirical evidence for their PTG model.

The first domain, relating to others, involves positive changes in interpersonal relationships (Tedeschi & Calhoun, 1996). Trauma can foster a sense of interconnectedness with others and lead to more meaningful and supportive social connections (Calhoun et al., 2022). Individuals often report a deepened sense of empathy and compassion for others, leading to more meaningful and authentic connections and a strengthening of their social support networks. As individuals grapple with traumatic experiences, they have an opportunity to undergo powerful transformations that enhance their overall sense of well-being and contribute to a more meaningful and fulfilling life. Improvements in relationships and social support systems have implications for overall well-being and positively impact mental health.

New possibilities, the second domain, refers to how individuals experiencing PTG may perceive an expanded range of potential opportunities (Tedeschi & Calhoun, 2004). Traumatic events can prompt individuals to reevaluate their goals, values, and priorities, leading to a greater openness to novel experiences and a willingness to explore uncharted territories (Muldoon et al., 2019). This domain underscores the idea that growth can emerge from reimagining one’s future in the wake of adversity.

The third domain, personal strength, involves the development of an improved sense of resilience and capabilities in the face of adversity (Tedeschi & Calhoun, 1996). Individuals who develop personal strength as a part of PTG often report a greater sense of self-efficacy, improved coping skills, and increased self-confidence. This domain reflects the idea that trauma can catalyze personal growth, enabling individuals to recognize their inner strength.

Spiritual change, the fourth domain of PTG, pertains to shifts in an individual's beliefs, values, and spiritual or existential mindset (Tedeschi & Calhoun, 1996). Trauma can lead to reevaluating one’s sense of purpose and meaning in life, often resulting in a deeper connection with spiritual or existential beliefs (Peres et al., 2007). The significance of existential growth and the search for meaning in the aftermath of adversity is emphasized in this domain.

The fifth and final domain, appreciation of life, emphasizes an enhanced sense of gratitude and a deeper appreciation for various aspects of life that were previously unseen or unacknowledged (Tedeschi & Calhoun, 2004). One explanation for this is that individuals who have suffered a traumatic event may develop a greater awareness of the fragility of life, leading to a more profound appreciation for the “small things” in life. This domain highlights the transformative power of trauma by supporting a sense of gratitude and mindfulness.

These five domains provided by Tedeschi and Calhoun (1996) afford a comprehensive and detailed framework for understanding the potentially transformative nature of trauma by highlighting the potential for positive psychological changes in its aftermath.

There is a wide range of reports regarding the timeline for the manifestation of PTG following an adverse or traumatic event. Research shows that PTG is not confined to a specific timeline, as it can emerge anytime from two weeks to many decades after a traumatic event (Fogle et al., 2020; Frazier et al., 2001; Park et al., 2005). This variability in the onset of PTG highlights its dynamic nature and emphasizes the importance of considering individual differences in the processing of trauma. It is critical to note that it is never too late to experience PTG. Regardless of the timing of the adverse or traumatic event, positive psychological change is always a possibility.

Interestingly, studies have suggested that PTG can fluctuate over time. However, research findings are mixed. One study found that PTG tended to decrease with age (Bachem et al., 2018), while another reported that PTG increased (Frazier et al., 2001). These contradictory findings emphasize the need for further research to understand the nuanced temporal patterns of PTG in different populations.

But given the dynamic nature of PTG, it is vital to engage in strategies to help support the development and maintenance of these positive changes. Research has shown that PTG in older adults is associated with adaptive coping strategies to help protect against the impact of new stressors (Park et al., 2005). PTG has been associated with improved attitudes toward existential concerns and mortality among older adults.

Facilitating Post-Traumatic Growth

Understanding the factors facilitating PTG in older adults is essential for designing effective interventions and support systems. Several factors have been identified that promote PTG in this population. The first factors are social support, connectedness, and community. Recent research has consistently emphasized the pivotal role of strong social support in facilitating PTG (Calhoun et al., 2022). These social relationships serve as a protective buffer against the negative psychological effects of trauma, offering a secure space for emotional expression and sharing.

Through open communication and empathetic interactions with friends, family members, partners, or support groups, older adults can process their thoughts and emotions with the support of others. Moreover, social support can provide opportunities to gain perspective and reduce feelings of isolation. Finally, feeling integrated in communities can foster a sense of belonging and purpose (Calhoun et al., 2022). Older adults who remain socially engaged are more likely to perceive their lives as meaningful and interconnected with the broader community.

A clear and meaningful purpose serves as a guiding framework that helps people make sense of traumatic events and find meaning through adversity. The pleasure of pursuing hobbies, engaging in volunteer work, or actively contributing to their families and communities can renew life meaning. This sense of direction is a psychological anchor during difficult times, providing a continuous and stable sense of self. Additionally, investing in developing a renewed sense of purpose can help protect against the psychological effects of future adversities (Park et al., 2005).

Spirituality and religiosity also have emerged as influential factors in promoting PTG among older adults (Malone & Dadswell, 2018). Facets of an individual’s belief system can provide comfort and hope in the aftermath of adversity or trauma. Spirituality and religiosity often involve a search for deeper meaning and purpose, which aligns closely with the domains of PTG (Russano et al., 2017). For many people, their beliefs offer a lens through which they can interpret life events. In times of crisis, spirituality and religiosity can enable older adults to find strength and resilience, whatever their beliefs. Moreover, religious practices often encourage forgiveness, acceptance, and compassion, which are valuable components of the growth process.

Alternatively, believing in yourself, otherwise known as self-efficacy, plays a pivotal role in the context of PTG among older adults. Self-efficacy refers to an individual’s confidence in their ability to manage and control their environment (Bandura et al., 1999). In the aftermath of trauma, self-efficacy beliefs can empower individuals to actively engage with their experiences and take meaningful steps toward positive psychological growth. Individuals with a strong sense of self-efficacy are more likely to perceive themselves as capable of overcoming challenges and embody a sense of mastery (Bandura et al., 1999).

This belief in their competence may fuel their motivation to seek resources and support while applying adaptive coping strategies essential for PTG. Importantly, research with older adults has shown that self-efficacy and a sense of purpose or meaning in life are strongly associated with PTG (Greenblatt-Kimron et al., 2022). A strong sense of purpose is thought to enhance self-efficacy because the person has a clear direction. In turn, self-efficacy can empower individuals to actively pursue their purpose, leading to a mutually reinforcing cycle of growth and personal development.

Challenges with the PTG Concept

However, it is essential to critically consider whether promoting PTG inadvertently places pressure on trauma survivors to grow. While the concept of PTG is undoubtedly appealing, it is not without its share of controversy. Some argue that promoting PTG may inadvertently pressure survivors to experience positive changes in the aftermath of trauma (Jayawickreme et al., 2020). Survivors who feel compelled to demonstrate signs of growth may feel inadequate or guilty if they fail to meet expectations. This pressure to grow post-trauma may undermine the authenticity of the healing process, potentially causing more psychological distress.

Additionally, the idea that trauma survivors should strive to realize positive changes in their lives as a result of their experiences may be controversial. It may inadvertently downplay the validity of their negative emotions and the challenges they encounter, minimizing the significance of their suffering. There are risks inherent in establishing PTG as a goal to be achieved because of the potential to overlook the complex and diverse responses individuals have to trauma stressors.

Furthermore, the complex relationship between PTSD and PTG illustrates the difficult journey many trauma survivors must endure to process the devastating impact of a traumatic event. Many people experience PTG simultaneously with PTSD symptoms (Cadell et al., 2003; Lev-Wiesel & Amir, 2003).

A study examining PTG in veterans found a “U-shaped” inverted relationship between PTG and PTSD. That is, veterans who screened positive for PTSD reported more PTG than veterans who did not screen positive for PTSD (Tsai et al., 2014). Two meta-analyses revealed a significant relationship between the two, where the highest levels of PTG occurred at intermediate levels of post-traumatic stress (Peters et al., 2021).

It is advantageous to carefully consider how the concept of PTG is promoted to older adults after a traumatic event. Older adults have a lifetime of experiences that typically include traumatic events and losses. The pressure to find growth in late life may be compounded by unresolved past traumas, making it crucial to approach PTG with sensitivity. Each person’s path to PTG is unique. To foster a supportive environment for navigating the complexities of their past experiences while seeking post-traumatic growth, it is important to recognize that older adults have different cultural backgrounds, lived experiences, coping strategies, and needs. This calls for a more nuanced approach that respects individual differences and acknowledges the potential for delayed or fluctuating growth trajectories in older trauma survivors.

The intricate interplay between aging, trauma, and PTG presents a multifaceted landscape that requires further research and treatment development. The prevalence of adverse or traumatic events across the lifespan underscores the importance of understanding the dynamics of PTG, particularly among older adults. A growing body of literature suggests that PTG is not limited to a specific timeline and can emerge at various points in one’s life, emphasizing the dynamic nature of this phenomenon. Research can inform and refine clinical practices used with older adults who are seeking to attain positive psychological changes at any point in their lives, regardless of the timing of their adverse or traumatic event. The psychological consequences of trauma can be enduring. The physical and cognitive changes experienced by older adults as they age underscore the complexity of treating trauma-related issues in this subgroup of the population. The resurgence of trauma-related symptoms occurring during major life transitions in older adulthood emphasizes the need for tailored support and interventions.

Social factors, including the loss of social support networks, loneliness, and isolation, significantly impact the mental health outcomes of older adults who have endured trauma (Calhoun et al., 2022). Importantly, recognizing the role of culture and historical context in shaping the experiences of older adults is crucial, particularly considering the collective and repeated traumas many have endured. These factors influence coping styles, access to resources, and attitudes toward the use of mental health services. By fostering PTG and embracing the factors contributing to its development and maintenance, it may be possible to mitigate some of the negative effects of trauma, leading to an increased sense of well-being for many older adults.

Julia Weinman, MS, MA, is a doctoral candidate at Palo Alto University in Palo Alto, CA. You may contact her at jweinman@paloaltou.edu. Lisa M. Brown, PhD, is a professor and director of the Trauma Program at Palo Alto University and an adjunct clinical professor and member of the Human Rights in Trauma Mental Health program at Stanford University School of Medicine. She may be contacted at lbrown@paloaltou.edu.

Photo credit: Shutterstock/Reggie Lee

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