Getting Back to “Normal” vs. Posttraumatic Growth: Ways for Individuals, Communities, and Societies to Grow in Response to the COVID-19 Pandemic
Chelsea Sokolow and Emma Miller, MSW, LCSW
Western Carolina University
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Researchers in psychology and related fields have developed the theory of posttraumatic growth (PTG) to explain how people can experience major positive transformation in response to traumatic events or experiences. A PTG perspective offers seemingly counterintuitive yet potentially effective ways of moving forward through trauma that go beyond adaptation, resiliency, recovery, or a return to the status quo. Instead, PTG allows for generative and positive changes to pre-trauma patterns of functioning. The COVID-19 pandemic and the accompanying socio-political turmoil of 2020 have disrupted individual and group routines and structures in ways that are both traumatic and profound, giving rise not only to a health crisis, but to human, economic, and social crises as well. In many ways, the cumulative traumatic events and experiences of 2020 present an opportunity for PTG. This perspective invites individuals, families, organizations, and communities in Western North Carolina and beyond to engage in intentional meaning-making and positive transformational changes. Research has shown that we, individually and collectively, can grow to constructively surpass pre-pandemic measures of functioning and well-being.
Introduction: The Social Work Perspective
In Kintsugi, the Japanese art of repairing cracked pottery with gold, silver, or platinum lacquer, the history of breakage is incorporated into the beauty and strength of the reconstructed piece. In many arenas, such as startup entrepreneurship, challenging ordeals and difficult losses are treated as an inevitable part of the process, but also viewed as opportunities for learning and improvement. Similarly, in social work and related fields, the concept of posttraumatic growth (PTG) explains how the human psyche, when faced with disruptive trauma, can experience transformational growth.
The idea that navigating struggle, hardship, and adversity can lead to growth is not new. In fact, the transformational potential that accompanies human suffering has been a much-explored theme throughout human history. It was only since the 1980s, however, that scholars have been systematically studying the complex interrelations between beneficial growth and trauma. Today, this same research community is applying the theory of PTG to the collective trauma of COVID-19 and the accompanying social-political turmoil of 2020.
The discipline of social work is focused on enhancing human well-being and pays particular attention to the experience of individuals within a social context and the “environmental forces that create, contribute to, and address problems in living.” From a social work perspective, the concept of PTG provides useful and hopeful insight for approaching the COVID-19 pandemic and the continuing challenges from 2020. This insight has been used to develop practical skills and tools for use by individuals, families, communities, and societies.
Social work as a field is deeply rooted in a constructive understanding of the nature of human experience. The scope of social work’s attention is broad, and includes addressing the personal and interpersonal aspects of people’s lived experiences, as well the structural impacts of policy, socialization, and culture. What is more, social work is a values-based discipline and profession. The National Association of Social Workers (NASW) has codified the discipline’s and profession’s commitment to service, social justice, valuing the inherent dignity and worth of people, prioritizing the importance of human relationships, and acting from a position of integrity and competence. Additionally, the NASW mandates that social workers challenge injustice through engaging in social and political action. This mandate provides guidance to social workers as they engage in the PTG process.
In this brief, we explain what PTG is and how it works. We then apply the concept to the context of the COVID-19 pandemic and the socio-political turmoil of 2020, exploring how useful tools of personal practice and social participation can be critical ingredients to supporting positive transformational growth moving forward.
COVID-19 and Trauma
According to the World Health Organization, a pandemic officially qualifies as a disaster. The United Nations Office for Disaster Risk Reduction (UNDRR) defines a disaster as “a serious disruption of the functioning of a community or a society causing widespread human, material, economic, or environmental losses which exceed the ability of the affected community or society to cope using its own resources.” This definition of disaster is similar to a PTG perspective on trauma in that it emphasizes the stressors placed on a community’s adaptive resources and the inability of the community to function as normal. It is not a far reach to imagine that the COVID-19 pandemic has disrupted many people’s sense of certainty, and understanding of the world, in traumatic ways.
Through a survey conducted by the PEW Research Center six months into the pandemic, it was estimated that over half of Americans expect their lives to remain significantly changed even after the pandemic is over.  In many ways, COVID-19 is a novel experience of mass global trauma – with impact affecting every aspect of society. How people care for physical and mental health, navigate access to healthcare, technology, employment, finances, housing, education, family life and childcare, social life, religious services, travel and basic tasks like grocery shopping and running errands, has shifted significantly. Indeed, this shift is no doubt interrupting many people’s deeply held assumptions about how the world around them works and why. The COVID-19 pandemic and accompanying socio-political landscape of 2020 have been immensely individually and collectively traumatic. Although different people have been affected on different orders of magnitude, very few, if any, people have been entirely unaffected. In addition, COVID-19 has pointed an undeniable spotlight at preexisting racial and class disparities. Additionally, helping professionals and care providers face the added risk of vicarious and secondary trauma.
What is posttraumatic growth and how does it work?
The concept of PTG refers to positive psychological change that occurs in response to the experience of trauma. Trauma in this context refers to experiences that stress one’s adaptive resources and challenge one’s fundamental assumptions, core beliefs, and understandings about the world and one’s place within it. The growth following trauma is demonstrated by profound positive shifts in thinking and relating to the world. In individuals, PTG often results in a sense of personal strength, growth, or capability, increased insight into oneself, and a change in values or priorities. It can also foster a greater appreciation for life, strengthened relationships, spiritual or existential development, and a heightened sense of possibility or hope. Through the organic process of rebuilding and reconstructing one’s disrupted worldview, transformational growth may occur. PTG is distinct from the concepts of resilience, hardiness, and optimism; although these are characteristics that can help individuals navigate adversity and weather the proverbial storm of change. PTG, in contrast, is not a personal characteristic, but rather a process and an experience. It is the act of struggle in and of itself that creates the conditions for growth.
Researchers have been able to measure PTG. This is due in great part to the work of psychologists Richard Tedeschi and Lawrence Calhoun, currently part of the PTG Research Group at the University of North Carolina at Charlotte, who are the original creators of the Posttraumatic Growth Inventory (PTGI). The PTGI aims to both unify and clarify a conceptual theory of PTG, and to create a functional tool to quantitatively measure and assess the experience of positive psychological growth following trauma. Since its creation, the PTGI has been translated into 22 languages, and empirical evidence in support of PTG has been found in numerous populations around the world. Ample scholarly literature has shown that a vast array of challenging life experiences can be catalysts for PTG. From the PTG perspective, trauma is understood to be present in those challenging life experiences that cause psychologically seismic disruptions of one’s culturally influenced, but individually held, core belief systems. By this definition, what is traumatic about an event is not only the negative experience of the event itself, but the ways in which the event challenges what people believe to be true about their lives and the world in general. In other words, how people perceive the impact of trauma on their lives matters tremendously. Traumatic events threaten one’s sense of safety, identity and anticipated future. The extent to which one’s assumptions are challenged, especially when it comes to “the benevolence, predictability, and controllability of the world,” the greater the possibility of PTG. Tedeschi and Calhoun utilize the metaphor of rebuilding after an earthquake to describe the cognitive process of worldview restructuring that must occur in response to the changes brought on by trauma so that people can create a new narrative more resistant to shattering in the future.
Tedeschi and Calhoun emphasize, however, that caution should be taken to not frame the experience of trauma as a simple precursor to positive growth. Trauma can and often does lead to major distress psychologically and physically. Yet, distress and PTG frequently coexist. What PTG represents then, is quite possibly the result of attempts at psychological survival, emotional relief and cognitive clarity in the face of immense distress. What is important to recognize is that the same psychological processes that allow for managing distress can also produce transformational change. Imbedded in the conceptual framework of PTG, and present in the prevailing ethos of social work, is the belief that people are experts on their own lives. Some changes are easily observed by other people, but the intricacies of how people interpret what’s happening in the world around them in order to make sense of their own lived experience is often a process that is not immediately visible to others.
The Five Domains of Posttraumatic Growth
PTG is not the same as an increase in well-being or a decrease in distress but rather is measured according to five specific domains. The first domain of PTG has to do with developing a sense of increased personal strength and capability. Somewhat paradoxically, this increased sense of strength is often paired with a heightened awareness of vulnerability. Those experiencing growth in this domain often reach an acceptance that bad things can and do happen accompanied with a belief that “if I can handle this, I can handle almost anything.”9 The second domain of PTG involves a heightened sense of hope. Often those experiencing growth in this domain discover new possibilities and life paths that they were not aware of pre-traumatic event. These new-found possibilities can give people the hope that their lives can and will improve. The third domain of PTG centers around the capacity for improved relationships and ways of relating to others. Those who report growth in this domain often focus on how much they cherish their social connections and want to give priority to nurturing relationships with the people they are close to. The fourth domain of PTG involves a greater appreciation of life and a shift in priorities and values. People experiencing growth here tend to slow down, take fewer things for granted and engage in deep reflection about what is most important to them. And finally, the fifth domain of PTG has to do with spiritual and existential development. In this domain, people experience an increased ability to handle paradox and engage with existential questions. Those who are religious often experience a strengthening of their faith.
What Leads to Posttraumatic Growth?
As mentioned, the field of social work is concerned about not only the individual but also families, organizations, communities, and societies. Understanding what leads to PTG can shed light on practical implications for each of these entities. The necessary conditions for PTG to occur in each case are twofold. They include making sure basic safety and survival needs are met and managing the initial distress in response to a novel experience of trauma which can be debilitating.
Beyond these initial conditions, two things have considerable empirical support for their role in the PTG process. One essential aspect of PTG is deliberate rumination and cognitive processing. This takes place when someone who has experienced trauma creates a new narrative that is able to both make sense and meaning of the role of that trauma in their life. This processing can be supported through writing or talking through it with others. A family or a group can do this as well when they construct a new narrative that makes meaning of the trauma through processing together or accessing a facilitator. A second critical facet of PTG has to do with social connection and support. On the individual level, an expert companion can help. An expert companion is a peer with lived experience who can aid the PTG process by helping weave together ideas and perspectives and by participating in the crafting of new narratives that make meaning of events both before and after the trauma. This peer support can be critical to PTG, as an expert companion is likely seen as credible in the eyes of the trauma-survivor. Furthermore, they can help facilitate trust, intimate connection, vulnerability and self-disclosure. Additionally, social support is thought to bolster individuals’ tolerance for distress, and therefore creates the metaphorical space for necessary cognitive processing. Families and groups can provide expert companionship through offering social connection and support to other families or groups who have struggled with similar trauma and survived. For example, families who have previously had their newborns in a neonatal intensive care unit could participate in a support group setting that includes families who are currently going through or who have just gone through that experience. Seasoned first responders supporting disaster response personnel during critical incident stress debriefings serves as another example of the role of expert companions in a group setting.
Collective Social Transformation: COVID-19, 2020 and Beyond
Communities and societies have been impacted by collective experiences of trauma, like the COVID-19 pandemic. In 2020, there has been a rise in psychological distress, financial strain and instability, unemployment, and many other types of acute hardship. For many, this collective trauma also challenges core beliefs surrounding health, security and stability, the responsibilities and obligations of governments, race and racism, and social justice throughout much of the world. These experiences have the potential to lead to PTG and social transformation. Collective traumas can interrupt socially shared narratives and raise questions of individual and group identity, the values or principles that should guide us, and the meaning the trauma has for society.  Collective trauma can be a catalyst for a healing crisis and create the potential for accelerated growth in organizations and communities that otherwise might take years to occur.
At the heart of societal level PTG is participation, that is, finding purpose and meaning in service to others and in support of collectively shared core values. An example is highlighted by a study conducted with community members in Puerto Aysén, Chile which found that active engagement in the social process was a key predictor of PTG. The study also found that collective processing of events, social participation, and acts of solidarity and resistance in the face of social violence enacted by state institutions correlated with higher levels of PTG in individuals.
Opportunities for Transformation in Western North Carolina and Beyond
For the two of us, as social workers who are deeply invested in enhancing the well-being of humans and societies, our work leads to the pragmatic question: Where can we all go from here? PTG often happens naturally without formal intervention but it can also be facilitated in actionable ways. PTG can be fostered through education promoting insight into trauma and its effects, and the teaching and learning of emotional awareness and regulation strategies. It can be enabled by creating opportunities for open and vulnerable conversations amongst friends, peers, families, and work communities, thereby supporting intentional discussions and efforts to develop a narrative able to grapple with paradox and create meaning. PTG can also be aided by encouraging engagement in service to others and social participation.
Social workers, in particular, are in a unique position to bridge the gaps between people, communities, organizations and institutions, and support the processes of education and narrative reconstruction. Social workers understand that the avenues through which people are able to create meaningful understandings of their own lives and their place in the world are greatly shaped by the historical and political moment, their positions within society, and their relative access to resources, power, and privilege.
When we are hit with great trauma, it often forces us to give up preexisting understandings and assumptions about the world, and the goals and aspirations that go with them as well. It becomes, as Richard Tedeschi and Lawrence Calhoun note, “clear that the old way of living is no longer appropriate in radically changed circumstances.” COVID-19 has changed our world. We can’t go back to “normal,” but we can use our experience over the last year, all of the trauma, grief and struggle as grist for the mill. The work ahead of us is both conceptual and pragmatic. We can initiate the difficult and often vulnerable conversations that allow us to reassess our values and priorities with intentionality, and that move us towards creating new ways of understanding the world that take into account the shifts and changes brought to light through the trauma of the COVID-19 pandemic. Additionally, we can advocate for federal, state, local, and organizational policies that allow for people to consistently be supported in meeting their basic needs, and therein create a context in which people can begin to manage distress in ways that allow them to move towards PTG.
The impact of COVID-19 on our country challenges cultural narratives of individualism and self-determination and brings to the forefront our interconnectedness and interdependence, emphasizing that health is much more than a private asset, and illustrating the need for a politics of collective health and well-being. Yet so much of the collective PTG process comes down to individuals’ willingness to grapple with difficult topics, and to do so in collaboration with others despite the discomfort that doing so might cause. We are forced to more deeply interrogate cultural beliefs and behaviors that affect our collective health, like, for example, nationalism, xenophobia, United States exceptionalism, racism, classism, sexism, colonialism, and other oppressive and inequitable systems and beliefs. The COVID-19 pandemic highlights the relationship between health and the social, economic, and political landscape, and spotlights where we are collectively vulnerable. In highlighting these vulnerabilities, opportunities for growth are also brought to light. We are invited to create more just systems within our society, starting with the creation and fortification of formal and informal social safety nets.
It is important that we, on an individual, organizational, and institutional level, actively embrace the challenging paradox that the pandemic is a major trauma with consequences that should not be downplayed, and that it can also be used as a catalyst for transformational change. It is not the trauma itself that causes the growth, but rather the way individuals and groups interpret and respond to the trauma. This goes beyond adaptation, resiliency, recovery, or a return to “normal.” The old status quo not being an option, we can begin to collectively make meaning out of the events that have happened to us, and to decide the best ways to respond, by asking some of the following questions: In what ways can we recalibrate and shift around our priorities to better care for the most vulnerable among us? What new opportunities have emerged? How can we better support each other on both interpersonal and institutional levels? What policies and procedures support well-being? What needs to change? What kind of future do we want to create? How do we, individually and collectively, participate in the imagining and the creating of that future? Starting here and now we can begin to let go of the illusion that things will ever go back to “normal” and get on with the often painful yet potentially rewarding process of growth.
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About the Authors
Chelsea Sokolow is a first year Master of Social Work (MSW) student at Western Carolina University (WCU). Before starting at WCU, she completed a B.A. in Latin American and Caribbean Studies at Brown University. Chelsea’s current interests within the field of Social Work include clinical practice, decolonizing social work, and abolitionist praxis. firstname.lastname@example.org. Emma Miller, MSW, LCSW is an Assistant Professor of Social Work and the U.S. Health Resources and Services Administration’s (HRSA) Behavioral Health Workforce Education and Training Program (BWHET) Project Coordinator at Western Carolina University. email@example.com.
Readers who wish to learn more about trauma, posttraumatic growth and rebuilding after trauma may appreciate the following texts. Posttraumatic Growth: Theory, Research, and Applications by Richard Tedeschi et al. (2018) provides a comprehensive overview of the concept. Richard Tedeschi and Bret Moore’s (2016) The Posttraumatic Growth Workbook: Coming Through Trauma Wiser, Stronger, and More Resilient aims at guiding individuals through their own process of navigating and understanding trauma and PTG. In The Politics of Trauma: Somatics, Healing and Social Justice, Staci Haines (2019) writes for therapists and social activists alike, and explores the interdependent nature of trauma healing and social change. In Narrative Medicine: The Use of History and Story in the Healing Process, psychiatrist Lewis Mehl-Madrona (2007) explores the way storytelling has historically been used as a healing modality in indigenous communities. Social worker Resmaa Menakem (2017) explores the connections between trauma, racism, and healing in My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending our Hearts and Bodies. Social justice facilitator Adrienne Maree Brown’s (2017) Emergent Strategy: Shaping Change, Changing Worlds offers an imaginative and visionary framework for navigating change and resisting oppressive narratives.
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Barroso, A. (2020, October 30). About half of Americans say their lives will remain changed in major ways when the pandemic is over. https://www.pewresearch.org/fact-tank/2020/09/17/about-half-of-americans-say-their-lives-will-remain-changed-in-major-ways-when-the-pandemic-is-over/
Brown, A. M. (2017). Emergent strategy: Shaping change, changing worlds. Chico, CA: AK Press.
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Menakem, R. (2017). My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies. Las Vegas, NV: Central Recovery Press.
Mehl-Madrona, L. (2007) Narrative Medicine: The Use of History and Story in the Healing Process. Rochester, VT: Bear & Company.
National Association of Social Workers (NASW). (2017). Read the Code of Ethics. https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english
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