Two psychological outcomes may manifest themselves in individuals following significant trauma; these are post-traumatic stress disorder (PTSD), and post-traumatic growth (PTG). PTSD is characterised by feelings of vulnerability, hopelessness, and depression due to impaired function of the pre-frontal cortex (PFC), and an increased dominance of the amygdala(1,2). This translates into a decrease in goal-directed regulation of thought and behaviour (executive function), and an increase in emotional and habitual behaviour, that can lead to pathological psychological disorders(1,3,4).
In contrast, PTG is a positive psychological response, resulting in increased executive function of the PFC(5). Diverse definitions of PTG exist, some mark it as a coping method, others acknowledge it, rather, as the outcome of coping with psychological distress(6). But the terminology of ‘post-traumatic growth’ provides a fairly concise definition of nature of the phenomenon; it is associated to severe distress and crisis, from which lasting life-changes are generated(7). These outcomes persist far beyond the recovery period of the trauma; therefore, PTG can certainly be defined as a responsive outcome to trauma(7). A significant difference between PTSD and PTG is that the former tends to be more of an autonomic, passive mental state, while the latter is a more deliberate, constructive state, where character growth occurs(4,8).
Psychological response following trauma is largely dependent upon the nature of the event and life circumstances surrounding the individual(9). Despite this, several characteristics have been identified to predict PTG following trauma(5,10,11). Understanding the different traits conducive to PTG is important, for it is to the degree that we understand its antecedents, that we are able to effectively facilitate it(12). In this essay lifestyle and personality traits which predict post-traumatic growth (PTG) will be examined.
The Post Traumatic Growth Inventory
Several authors acknowledge five traits to be both substantively, and resultingly, associated with PTG. These traits have been independently studied, and culminatively quantified as the Post Traumatic Growth Inventory (PTGI)(13). These traits are: a positive meaning in life, meaningful relationships, future-orientation, self-efficacy, and possessing an inner drive toward personal-growth(5,7,10,11,13–15).
Positive meaning in life
Finding a positive meaning in life as a response to a traumatic event is a characteristic of PTG. It manifests in greater value being attributed to aspects of life formally taken for granted. This thought behaviour can serve to counteract long-term depressive symptoms and associated quality of life(10).
There are several avenues for discovering a positive meaning in life, be it through relationship, community involvement, or parenting(14). Positive and sincere spirituality is associated with a positive meaning in life, and particularly in transitioning from anxiety-ridden rumination of an event into PTG(16). Religious participation was also found to be a key component of a three-tier multiple regression predicting PTG(17). A meta-analysis found religious coping and positive re-evaluation to be among the highest predictors of PTG(18). Possessing a positive meaning in life is linked with optimism, and the ability to intelligently evaluate past events in a positive manner; an essential element of PTG(18).
A positive meaning in life prior to a traumatic event is protective against PTSD; it gives stability, purpose, and a greater sense of certainty. The antithesis of this state of being is one of uncertainty, which is positively correlated to anxiety, and a lower quality of life(19,20).
Procrastination is positively correlated with anxiety, while conscientiousness has been negatively associated with anxiety(21). Therefore, finding a finding positive purpose, living deliberately and with greater certainty, causes one to be more conscientious, and protects against vulnerability to trauma.
It is important for those at risk of experiencing trauma through employment (such as emergency service professionals), that they find meaning and purpose aside from that which they get from work. If an employee experiences a traumatic incident through their work, they are better equipped to recover if their purpose/meaning for life is found outside of work.
Survivors of trauma may develop an increased compassionate and empathetic nature, and become more conscientious(2). While possessing meaningful relationships is an important predictor of PTG, it is only moderately predictive of itself, and more powerful when used in combination with other components of the PTGI (15,18).
Future-orientation is an intrinsic component of the human psych; it includes an individual’s feelings, plans, motivation, and thoughts for their future(22). It includes not just an awareness of the future, but also an understanding of one’s ability to create and accomplish a relevant plan of action, and is, as such, linked to PFC function(22). High scores in future-orientation is therefore positively associated to PTG(23).
Self-efficacy was first described as "how well one can execute courses of action required to deal with prospective situations"(24). A strong belief in one’s self-efficacy has been demonstrated to increase their ability to overcome obstacles in a sustained manner, while low esteem of one’s self-efficacy predicts a relative lack of coping behaviour(15,25,26).
PTG has been defined as positive change in personality, therefore it follows suite that those who possess an attitude of personal-growth (PG), further predispose themselves towards PTG(8,27). Individuals that actively pursue PG demonstrate cognitive curiosity, intellectual exploration, and have an active imagination(28). Openness to experience is synonymous with PG, and is a component of a well-known five-factor model of personality types (18,29). Meta-analyses have linked high scores of openness to experience to higher rates of PTG (25).
The pursuit of PG is to a large degree the keystone upon which the development of all other traits rest upon. That other traits are subsequent to desires for PG is demonstrated in that a person having gone through PTG, will report an increased sense of self-efficacy, another trait independently associated with PTG (25). PG is pertinent to one’s self-efficacy, as it is by developing the beliefs a person possesses concerning their power to influence certain situations, that their actual power to overcome obstacles is developed(26).
So, the question follows, what traits can an individual adopt to foster PG? Four traits, both physical and psychological, have been identified to be either highly correlated, or substantive of PG.
It has been suggested that the five-factor model of personality structure described late last century can be subsumed within a “General Personality Factor” (GFP); that being a self-evaluative disposition(29,30). While there is debate whether the GFP is substantive or responsive, it nevertheless is a trait strongly associated to PG(26,31).
A keystone to post-traumatic growth
The function of the PFC is a major psycho/physiological difference between PTSD and PTG (1,2,5). It therefore behoves us to give attention the PFC as the hinge upon which the psychological outcome of trauma swings. PFC dysfunction is symptomatic of various mental illnesses including attention-deficit/hyperactivity disorder, and as such has undergone substantial research, with apparently promising prospects(32,33). However, despite popularity, a review of fifteen novel treatments for PTSD suggest that the majority of these emergent interventions have insufficient evidence in support of their efficacy(33).
Therefore, investigating lifestyle related behaviours associated with the development of the PFC is important. A cursory look at three easily attenable lifestyle factors which strongly associated with PFC function provides a surprisingly effective, yet simple guide to developing the PFC.
Recent studies proceeding from the Menzies Institute for Medical Research, as well as internationally, report a strong link between executive function and diet(34,35). High intake of meat, refined foods, and takeaway foods were associated with a significantly increased risk of depression, consequent high BMI was strongly linked to mental health problems and inflammation in adolescents - conversely, a diet rich in fruit, vegetables and wholegrains was protective against mental health problems in adolescents(34,35).
Exercise increases volume of PFC and increases cognitive power (36,37). Alternatively, a sedentary lifestyle is associated with an increased risk of frontal lobe dysfunction(38). Therefore, it is suggested that for PTG, optimising lifestyle related activities such as diet, and physical activity are effective methods for fostering PTG.
Behaviours, either physical or psychological, that are addictive in nature are strong correlates to PFC dysfunction and can lead to pathological mental states(39). Such behaviours include internet, multimedia entertainment, and pornography addictions(38,40,41). Behaviours associated with the reward circuitry in the human brain can lead to more emotional reasoning and other traits symptomatic of addiction(42). A recent review of the literature on internet and pornography addiction through the DSM-5, lead to the conclusion that pornography addiction shares the same framework, and similar mechanisms, as substance addiction; thus debilitating the PFC(42,43).
Developing emotional intelligence (EQ), a measurement of susceptibility to emotional reasoning, has been suggested as a factor strongly linked to psychological resilience(44). Addictive behaviours lower EQ, and a low EQ is associated with depression(35,42). Further, depression is linked with atrophy of the prefrontal cortex, resulting in a loss of executive function (45). Therefore scoring high in EQ increases an individual’s goal-directed regulation of thought and behaviour (executive function), and protects against emotional and habitual behaviour, and aids in the development of the PFC(1,3). Consequently, avoidance of pornography, substance abuse, internet and multimedia entertainment addictions, is important for predicting PTG.
Longer sleeping hours in combination with rising early, is associated with higher scores in conscientiousness and agreeableness, and results in higher serotonergic activity – thus countering depression(46,47).
There are a range of traits which may predict PTG. Personality traits positively associated with PTG may be cultivated by individuals who do not possess them intrinsically(27). PTSD and PTG may co-occur, thus a focus on one or the other outcomes may hinder recovery by masking potential growth factors(48).
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