Otras novedades introducidas por la Ley 26/2015

While the positive consequences of traumatic event exposure have received little research attention, this does not mean that it has been entirely overlooked. A body of literature does exist suggesting that some people may fmd some good emanating from their traumatic experiences. Some researchers in the field have explored the possibility of positive sequelae to traumatic events. Taylor, Wood, and Lichtman ( 1 983) studied

Posttraumatic Growth

the victims of life-threatening attacks, illness, natural disasters, and other such events. They suggested that not only do the majority of people exposed to these events appear to overcome the victimizing aspects of these situations, but also in some cases they seem to have actually benefited from the experience. They argued that while there will be some people who do not readjust successfully, most do, and they do so substantially on their own. Some individuals may even report an improved quality of life as a result of the experience. The ability to fmd good from harm often takes the form of fmding meaning from the experience and one of the ways this is done is by learning from the experience. Taylor et al. ( 1 983) considered that the search for meaning involves not only understanding why the event occurred, but also what the implications are for life from then on. This can entail a rethinking of attitudes and priorities to restructure life along more satisfying lines.

Janoff-Bulman (1 989a) explored individuals' psychological responses to traumatic events. From her perspective, traumatic events shatter individuals' basic assumptions about the world; and their feelings of invulnerability, unchallenged prior to the traumatic event, are shown to have been illusions. Janoff-Bulman commented, however, that there is a great deal of variability in people's reactions to a traumatic event. Some will be completely unable to reestablish any positive illusions their lives characterized by low motivation, depression, anxiety and hopelessness. However, most manage to retain or re-establish a positive view of the world and themselves, while simultaneously recognizing the limitations of these beliefs. One way they do this is by looking for benefits that can be derived from the situation. They speak of a new appreciation for life, recognition of what is really important, and a new sense of their own importance (Janoff­ Bulman, 1989b).

Collins et al. ( 1 990) interviewed 55 cancer patients about changes in their lives following

diagnosis. They found that while respondents reported both positive and negative changes following cancer, overall the respondents reported significantly more positive changes in their lives. The most common changes regarding activities or priorities were; living for the day or appreciating life, and doing things now instead of waiting. Regarding relationships, the most common changes were: becoming more sensitive to

Posttraumatic Growth

others feelings; becoming more sympathetic and compassionate; and putting more time and effort into relationships.

Aldwin et al. ( 1 994) hypothesized that the undesirable effects of military experience

would increase with the intensity of combat experience, and that there would be an inverted-u function for desirable effects; both low and high exposure to combat would result in lower levels of desirable effects than moderate exposure. They developed a deviation-amplification model in which both positive and negative outcomes can result from the same stressor. They suggested that perceived positive and negative military experiences would both mediate and moderate the relationship between combat exposure

and PTSD symptoms. That is, perceiving negative effects of military service (e.g.,

combat anxieties, loss o f friends, or death and destruction) would lead to higher levels of symptoms, whereas perceiving positive benefits (e.g., increased independence, self­ esteem, or coping skills) would lead to lower levels.

The researchers tested these hypotheses with 1 ,287 male veterans and found that the

veterans perceived both positive and negative consequences of their military service. However, more weight was given to the positive than the negative, with both increasing linearly with combat experience. Undesirable effects increased, and desirable effects

decreased, the relationship between combat exposure and PTSD (Aldwin et al., 1 994).

Although initially highly adverse, combat exposure did not preclude the experience of positive consequences over time. It appeared that both positive and negative sequalae coexisted in some complex pattern. Aldwin et al. suggested that once the possibility of positive outcomes to stressors was admitted, this results in a variety of other research topics to consider. For example, the ecological and psychological variables that led to a preponderance of positive or negative consequences of stress, the psychological processes by which stress or extreme trauma results in growth, and the ways in which the process can be facilitated.

McMillen, Zuravin, and Rideout ( 1 995) investigated aspects of perceived benefits from

childhood sexual abuse. The women in this study reported benefits in four main areas: they could protect their children from sexual abuse; they could protect themselves; they had increased knowledge of child sexual abuse; and they had grown stronger as people.

Posttraumatic Growth

The results from this study suggested that those women who perceived some benefit from their childhood sexual abuse were doing somewhat better than those who did not.

The authors considered that if future research warrants it, clinical approaches could be

developed to help those who are sexually abused to explore ways in which their lives may have improved.

Disaster research has highlighted possible changes for the better in people's lives following traumatic events. Joseph, Williarns, and Yule ( 1 993) studied survivors of the Herald of Free Enterprise disaster, and found that many were still traumatized three years later. However, an interesting fmding was that 83% of the survivors reported that they felt more experienced about life, and over half rated their life as changed for the better. This suggested that disaster responses could be both positive and negative. The authors extended their fmdings into the development of a measure to assess positive and negative responses to changes in outlook following disaster. This measure was then given to adult survivors of the sinking of the cruise ship Jupiter. To their surprise, the authors found that most of the survivors reported strong positive changes in their outlook on life. Over 90% agreed that they no longer take life for granted, that they value their relationships now, and that they no longer take people or things for granted. Nobody agreed that life had no meaning now, and only 6% agreed that they felt dead from the neck downwards. Overall, negative responses had far fewer endorsements than positive responses.

This raised the question as to whether a person could simultaneously experience both positive and negative changes in outlook. Joseph et al. ( 1 993) considered disaster research to be constrained by its focus on maladaptive behaviours. If both positive and negative responses were identified, this would more accurately identify those at risk of long-term disturbance, as it may be that people who experience positive outcomes, as well as negative ones may be less at risk. There is some evidence that fmding meaning in adversity is adaptive; Affieck, Tennen, Croog, and Levine (1 987) found that men who had perceived benefits from a heart attack, were less likely to have a subsequent attack and exhibited less morbidity eight years later.

Posttraumatic Growth

Researchers investigating the impact of exposure to traumatic events on emergency workers now consider that the impact of p articularly gruesome and prolonged disasters may result in greater than three to five percent of workers experiencing long-term distress (McCammon, 1 996). An interesting consideration, however, is the number of

workers who work on the front line of disasters and emerge unscathed. Regarding the symptoms experienced by police officers at the site of the Lockerbie air disaster Margaret Mitchell ( 1 990) commented, that what was surprising was not that some adverse effects were observed in these officers, but rather, that they managed as well as they did. Anderson et al. ( 1991 ) found over half the rescuers in a rail accident felt that the participating in the rescue had impacted on their lives in a positive way. This suggested to Anderson et al. that facing traumatic events did not necessarily lead to psychological morbidity, but instead may facilitate personal growth.

Stress-related growth was reported in a Swiss study of 264 people with spinal cord injuries (Znoj, 2000). This study described stress-related growth as a kind of emergency coping, which although not related to health in a direct way, could prevent worse outcomes. Growth was conceptualized as a capacity (either learned or inherited) that enabled the integration and learning of a variety of separated things (intelligence in a broad meaning). The study reported that stress-related growth was significantly and positively predicted by being female, by personal resources, by adaptive ways of coping, and by emotion regulation. This study also involved the partners of spinal cord injured people, and indicated that having personal and social resources was a prerequisite for stress-related growth.

Tedeschi, Calhoun, and colleagues (Tedeschi & Calhoun, 1 995, 1 996; Tedeschi, Park, & Calhoun, 1 998) have reported that in over half the people who have experienced traumatic events, reconstruction of schemas produces a view of the world and related behaviour that the survivor perceives as beneficial, not only for managing the trauma, but also for living life more fruitfully than it was prior to the trauma. These researchers have reviewed studies of the aftermath of bereavement, chronic illness, HIV, cancer, heart attacks, transportation accidents, rape and sexual abuse, and hostage taking. They conclude that no matter what the traumatic event was, similar personal transformations occurr. A recent study of 54 young adults, prescreened for experience of a traumatic