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"Posttraumatic Growth
Posttraumatic growth (PTG) refers to the positive psychological changes that individuals may experience as a result of suffering through a traumatic event (Tedeschi & Calhoun, 1996; Tedeschi & Calhoun, 2004). Tedeschi and Calhoun (1996) state that PTG is characterised by enhanced personal strength, deepened relationships, an increased appreciation of life, recognition of new possibilities, and spiritual development. Tedeschi and Calhoun (2004) further elaborated that PTG is not merely a return to pre-trauma functioning. They maintain that it represents a transformative experience, wherein survivors report growth that exceeds their previous baseline. This concept is rooted in cognitive theories, where the disruption of core beliefs forces individuals into a process of meaning-making, which can lead to growth.
However, the validity of PTG as a construct has been a subject of critical debate. One major concern revolves around the reliance on self-report measures like the Posttraumatic Growth Inventory (PTGI) to assess growth. Critics argue that such measures may assess perceived growth rather than actual, measurable change. This leads to inflated reports of PTG (Boals, 2023). Boals (2023) contends that high prevalence rates of reported PTG do not align with empirical evidence showing that trauma exposure typically results in adverse psychological outcomes (Christiansen et al., 2015). The overreporting of PTG may be influenced by cognitive biases and social desirability. Individuals might report growth as a coping mechanism to find meaning in their suffering, thereby maintaining a positive self-image (Wortman, 2004; Henson et al., 2021). Additionally, the PTGI's unipolar response scale emphasises positive changes without equally assessing negative changes. This potentially encourages respondents to overemphasise growth (Boals, 2023). Weinrib et al. (2006) found that while participants acknowledged growth on questionnaires, these reports did not always correspond with concrete examples of change in their personal narratives, suggesting a discrepancy between perceived and actual growth.
Furthermore, longitudinal studies often fail to provide robust evidence for genuine PTG when baseline pre-trauma measures are considered (Frazier et al., 2009). Ramos and Leal (2013) highlight that self-reported growth does not necessarily translate into observable behavioural or cognitive change. This raises questions about the construct's validity and whether reported growth reflects true cognitive development or an idealistic illusion. Moreover, emphasising PTG may inadvertently place pressure on trauma survivors to demonstrate positive changes, potentially invalidating their legitimate distress (Wortman, 2004). Henson et al. (2021) suggest that the pursuit of growth might lead to maladaptive coping strategies, such as denial or suppression of negative emotions, which can ultimately hinder long-term recovery. While the PTG model may have its limitations, it does not imply that the framework is irreparable. PTG offers a distinct lens through which to view trauma recovery, providing an alternative to purely pathological models of stress response.
Emotional Dysregulation in Veterans: Psychological Impacts on Personal and Family Well-being
Military personnel are frequently exposed to traumatic events, whether through direct combat, witnessing violence, or facing life-threatening situations. These experiences can have profound and long-lasting psychological effects. One of the ways it manifests is through emotional dysregulation (ED). Exposure to life-threatening events in combat can lead to chronic ED, with veterans often experiencing heightened emotional reactivity, numbing, and difficulty accessing adaptive coping mechanisms (Solomon, 1988; Solomon et al., 1992). This dysregulation is linked to PTSD, where individuals frequently suppress emotions or resort to avoidance strategies. Emotional suppression, while adaptive in combat situations, becomes maladaptive in civilian life, exacerbating emotional outbursts and anxiety. Specifically, Stanley and Larsen (2019) highlight how military training encourages suppression and compartmentalisation of emotions, which leads to habitual emotional suppression that is difficult to unlearn after returning from deployment.
As ED intensifies, its effects often spill over into personal relationships where it creates additional layers of conflict and emotional distance. Renshaw et al. (2011) found that veterans with PTSD often exhibit symptoms such as irritability, anger outbursts, and emotional numbing, which can strain marital and familial bonds. This emotional dysregulation impairs communication, leading to misunderstandings and decreased intimacy within the family unit. Solomon et al. (1992) found that Israeli combat veterans displayed withdrawal and aggression towards their spouses, resulting in heightened distress and psychiatric symptoms in their partners – a phenomenon termed secondary traumatisation. Furthermore, the pressure of reconciling their experiences with civilian life further disrupts their personal relationships, as many veterans feel their partners and family members cannot understand or relate to the trauma they have endured (Solomon, 1988).
These emotional outbursts not only strain the marital relationship but also negatively affect children. Harrison et al. (2014) reported that adolescents with a parent suffering from PTSD experienced emotional unavailability, leading to feelings of isolation and the assumption of adult responsibilities to compensate for the parental void. Furthermore, Lincoln et al. (2008) found that children in military families are at heightened risk for emotional and behavioural difficulties, particularly when there are preexisting stressors such as abuse or parental substance use. The emotional strain of deployment, compounded by the distress of the at-home parent, can exacerbate maladjustment. This can lead to disrupted attachment, emotional dysregulation, and increased instances of abuse. This creates a cyclical pattern of dysfunction that further strains family relationships and hinders recovery for both the service member and their children.
Posttraumatic Growth After Combat-Related Trauma
PTG among military personnel following combat-related trauma is influenced by several factors that facilitate positive psychological change despite adverse experiences. Tedeschi and Calhoun’s (2004) model provides a foundational framework. They theorised that self-disclosure and deliberate rumination are significant facilitators for PTG. They suggested that the deliberate rumination of traumatic events enables individuals to reconstruct their assumptive world and derive meaning from their experiences. This is particularly evident when individuals engage in deliberate reflection and disclosure with supportive others. Subsequent research has both supported and refuted this model.
For instance, Birrer and Michael (2011) offer a critical perspective on rumination, suggesting that while this cognitive process can facilitate meaning-making, it may also risk reinforcing distress if not carefully managed. They argue that excessive rumination can exacerbate distress and maintain a focus on the trauma, thereby inhibiting growth. While this critique raises valid concerns about the potential risks of unregulated rumination, it overlooks the evidence that deliberate, structured rumination (particularly when supported by therapeutic interventions or social support) tends to foster growth rather than impede it. (PUT MORE CITATIONS HERE) For example, Morgan et al. (2017), in a study of military veterans, found that deliberate rumination was positively associated with PTG, while intrusive rumination was linked to PTSD symptoms. They found that challenges to core beliefs led to both intrusive and deliberate rumination, but it was the deliberate rumination that was directly related to PTG. This supports Tedeschi and Calhoun's (2004) model.
Furthermore, Nordstrand et al. (2020) highlight the role of social support in PTG among military veterans. Their study indicates that both structural (the size of one's social network) and functional (the perceived quality of support) social support are significant predictors of PTG. Interestingly, they found that personal barriers to disclosing traumatic experiences predicted posttraumatic deprecation rather than growth. This suggests that while self-disclosure may facilitate PTG, as per Tedeschi and Calhoun (2004), the context and quality of the social environment are crucial. Veterans may face stigma or negative reactions when sharing combat experiences, which could impede growth. Therefore, the mere act of self-disclosure is insufficient; the response of the social network plays a critical role. Moreover, the literature consistently demonstrates that PTG can coexist with ongoing distress. Morgan et al. (2017) found that PTG and PTSD symptoms often coexist, indicating that growth does not necessarily equate to the absence of distress. This is consistent with Tedeschi and Calhoun's (2004) position that PTG is not simply the opposite of psychological distress but is an independent construct. The coexistence of growth and pain highlights the complexity of the recovery process, where individuals may experience positive changes alongside persistent struggles.
Psychological Interventions that Promote Posttraumatic Growth in Military Personnel
Considering the evidence on rumination and self-disclosure, it is clear that the relationship between trauma and PTG is not linear but instead influenced by numerous cognitive and social factors. Recent studies have emphasised specific cognitive and social processes that promote growth among military personnel. Lindstrom et al. (2013) found that the challenge to core beliefs was a significant predictor of PTG, with deliberate rumination serving as a crucial mechanism through which individuals reconstruct their assumptive world. Unlike intrusive rumination, which is associated with heightened distress and the maintenance of PTSD symptoms (see Morgan et al., 2017), deliberate rumination involves purposeful and reflective thinking about the traumatic event, enabling meaning-making and cognitive restructuring (Lindstrom et al., 2013). This deliberate processing allows veterans to reinterpret their experiences and integrate them into their narratives positively. Similarly, Russell and Mussap (2022) found that deliberate rumination mediated the relationship between certain military stressors and PTG. Their findings suggest that when veterans engage in deliberate rumination, they are more likely to experience growth despite adversity, supporting Tedeschi and Calhoun's (2004) model discussed earlier.
Self-disclosure emerges as another significant factor in promoting PTG among military personnel. Lindstrom et al. (2013) noted that participants who disclosed positive and negative consequences of their traumatic experiences reported higher levels of deliberate rumination and lower current stress. This aligns with previous discussions on the importance of supportive social environments in promoting growth. Self-disclosure facilitates deliberate rumination by allowing individuals to articulate and process their thoughts and feelings, thereby enhancing cognitive processing (Lindstrom et al., 2013). Moreover, self-disclosure and social support are inherently linked; the act of sharing traumatic experiences requires a receptive and empathetic audience. Monk et al. (2017) highlights this connection in their study assessing the impact of integrative intensive retreats for veteran couples and families. They found that participants reported reductions in trauma symptoms and increases in relationship adjustment and PTG following the retreat. The program emphasised community support, psychoeducation, and conjoint therapeutic sessions, creating an environment conducive to self-disclosure and mutual understanding. Such retreats provided veterans with opportunities to discuss their experiences openly, facilitating both deliberate rumination and the re-establishment of supportive relationships.
Similarly, Erbes et al. (2008) highlight the efficacy of couple therapy, specifically Integrative Behavioural Couple Therapy (IBCT), in facilitating PTG among returning military personnel and their partners. IBCT promotes acceptance and emotional expression within the relationship, addressing experiential avoidance - a common feature in PTSD that hinders recovery. By facilitating open communication and reducing conflict, the therapy enhances social support and provides a safe space for self-disclosure (Erbes et al., 2008). The acceptance component encourages partners to understand and embrace each other's experiences, which not only alleviates relationship distress but also promotes individual growth. These interventions demonstrate that psychological therapies focusing on relational dynamics can be instrumental in promoting PTG by strengthening deliberate rumination and facilitating self-disclosure within a supportive environment. By integrating cognitive and relational approaches, such therapies address both the internal processing and external support necessary for veterans to experience growth after trauma.
Conclusion
While the construct of posttraumatic growth has faced criticism regarding its measurement and validity, it remains a valuable lens through which to understand the potential for positive change following combat-related trauma. Military personnel often grapple with significant psychological challenges such as emotional dysregulation, impacting both personal well-being and familial relationships. However, research demonstrates that factors like deliberate rumination and self-disclosure are instrumental in facilitating PTG among veterans. Psychological interventions that cultivate these processes – such as integrative behavioural couple therapy and family retreats – show promise in promoting growth. Future research should focus on refining assessment tools to distinguish genuine growth from perceived changes and expanding interventions that effectively support veterans in diverse contexts, ultimately enhancing their recovery and well-being."