Our world has changed.
What is possible beyond this traumatic experience of the pandemic and how do we get there?
One of the most beneficial tools for post traumatic growth is working with a companion, such as a coach or counselor experienced in stress management and resilience training techniques. The key to doing this is through respecting what has happened and navigating a way forward, so you can find your place in a changed world.
Which of These Perspectives Sound Familiar to You?
If any of the following scenarios feel or sound familiar, then you too have experienced an event or series of events that is/are likely causing you trauma. A trauma challenges our ability to regulate emotions, disrupts our beliefs about ourselves and our world as well. Trauma changes our life story.
By identifying trauma, you can begin the necessary healing process that leads to post traumatic growth.
She woke diaphoretic, tachycardic and with memories of a 42 yo patient who shouldn’t have died; an unvaccinated young man who landed in the intensive care unit (ICU) with complications from COVID. In the end he coded and didn’t respond to the valiant efforts of the ICU team that she led. It wasn’t the first time she woke to this nightmare.
He had presented atypically at his family physician’s office, before the long list of symptoms came to be associated with Coronavirus infection. He was sent home; but not before he had transmitted the virus to multiple medical staff causing staff shortages. His test came back positive and by day 9, he was in the ICU on a ventilator.
Beyond absences caused by COVID illness, staff also hesitated to come to work because they were pregnant or caring for an elderly parent. Staff shortages became worse.
She knew there had been many turning points that if handled differently could have saved the patient’s life. Early on she had perseverated about all these decision points. His workplace could have offered remote working; the government could have distributed vaccinations out to essential workers unable to work remotely more quickly; the patient could have had a pulse oximeter to use at home to detect his declining oxygen saturation; the person who transmitted the illness to him could have been more cautious. She could have recognized the earlier signs of heart failure and trusted her gut instead of the requests of the family when they, in denial delayed treatment she knew was necessary.
Along with the thoughts of what could have been, came emotional distress. She was sad, angry and without confidence. She dreaded going to work, was lost as to how to enjoy her important connections with her family and in her community. It was difficult at times to stop the tears.
The Next Patient
As the pandemic progressed and vaccines were available to any adult who wanted one, the ICUs were populated with those who chose not to be vaccinated. The patients and their families were in disbelief as their loved ones died from a disease that they thought was less worrisome than the vaccination that could have prevented it. They didn’t trust the intensivist treatments and wanted to use the recommendations promoted in the press.
As the unvaccinated COVID patients continued to come through the doors of the ICU; she realized that the assumption that families trusted her to aggressively treat patients who could recover with evidence based medicine, was wrong. Intensivists across the country struggled as their world and their self image disappeared in a matter of months. It seemed that they were no longer the brilliant heroes that families trusted to save lives. Instead they were seen as getting in the way of life saving measures created by misinformation in the press. These disrupted assumptions about their role and their world, put in doubt the course of their life story. They began to doubt they would be able to help families navigate the difficult decisions of when to be aggressive with treatment and when to let go, the decisions that are so crucial in the ICU.
Rising above the traumatic experience
Largely, because of the extensive work of the VA system, we know a great deal about what it takes to recover and rise above traumatic experiences. Post traumatic growth (PTG) is the process of transformation that can occur in response to a traumatic event. By necessity, people develop a new way of thinking, feeling and behaving because their baseline way of functioning no longer serves them. They ultimately find new meaning in their life. Some are able to navigate this process naturally without help, others may find a companion or a therapist helpful. The process was first described by psychologists Richard Tedeschi, PhD and Lawrence Calhoun, PhD in the mid-1990s. They suggest five steps to positive growth.
First Element of Recovery
This involves an awareness of the physiological and psychological response to the traumatic event. Automatic rumination can be understood as a normal response to a painful event. Our brain investigates pain. Evolutionarily it served our species well to understand and avoid the things that were harmful to us. The physiologic response that was designed to get us out of an acutely threatening event is harmful if operating in a sustained mode. Stress causes disease. Understanding and normalizing this response is the first step to recovery.
Second Element of Recovery
Management of emotional distress involves handling the anxiety, insomnia and automatic rumination. Our default brain wanders in the life depleting muck of unhealthy thoughts. When we are not focused, we have thoughts of regretting the past and worrying about the future. We are not focused on the present. These ruminations cause anxiety and insomnia. Practicing presencing techniques such as relaxation, mindfulness, and creative endeavors, focus the mind positively and strengthen the connections and increase the real estate in our pleasure centers, reducing the ability of the flight, fight, freeze response to dominate our lives.
Third Element of Recovery
Self-exploration of current intrusive thoughts and effective support from companions is key to PTG. The disclosure takes many forms. This could be in private with journaling, poetry, art or sharing one on one or in support groups. The purpose of the self-disclosure is to begin to make sense of what happened, increase control over the thoughts, and move from automatic rumination to intentional constructive thinking. Social support during this phase can bring perspective to the intentional thoughts that can be helpful or merely provide a safe, nonjudgmental space to reveal pain.
Fourth Element of Recovery
This step integrates the work done in the first three phases to develop a new vision for life. The formidable distress is managed, the disruption of assumptions about who they are and what the world holds for them is resolved and they have emerged learning from and being transformed by the work. They have a realization that they alone are the authors of their life story and there is hope once again.
Fifth Element of Recovery
Through the development of articulated life principles, the traumatized individual is prepared for handling future trauma and developing new purpose in life. The translation of these revelations into daily life is the transformation that can occur with hard work and good support from other humans. The patient with the traumatic amputation as a result of an IED coaching special Olympics; the grieving wife of a fallen football player now leading efforts to prevent heat stroke in athletes; the physician with substance abuse disorder working beyond retirement age because of a new found passion for addiction medicine; are just a few examples of individuals who have been transformed. Some consider the traumatic event as both the worst and best experience of their lives.
An expert companion who is familiar with these five domains of PTG can hold space for and guide the traumatized individual on their journey to transformation. Teams can learn to respect what they went through, discover the strengths of their members and learn to move forward together. Growth is possible after a traumatic experience.
Richard G. Tedeschi, Jane Shakespeare-Finch, Kanako Taku, and Lawrence G. Calhoun in Posttraumatic Growth Theory, Research, and Applications; 2018