The idea of Post Traumatic Growth, or PTG, is a popular one – that survivors of traumatic events cannot only heal from their trauma, but may actually grow into a stronger, more driven, and more resilient person because of their trauma.
According to the Posttraumatic Growth Research Group at the University of North Carolina at Charlotte, PTG can be understood as positive change resulting from an individual’s struggle with a major life crisis or traumatic event (2014).
Where our other article PTG goes more in detail on the concept itself and the science behind it, this article provides you with practical tools to apply with your clients or students.
This article contains:
4 Positive Trauma Therapy Techniques
In 2011, United States Army Behavioral Science Officer Stephanie D. Nelson outlined a posttraumatic growth path (PTGP) for treatment of individuals suffering from PTSD. This treatment plan includes several techniques that the evidence suggests will aid those suffering from symptoms of PTSD, categorized into four chronological stages of treatment progression: (1) Deal, (2) Feel, (3) Heal, and (4) Seal.
The primary technique from each of the steps is described below.
1. Deal – Writing a Trauma Narrative
In the first step, therapists can assign the sufferer an initial exercise that will set the stage for the following steps and facilitate the healing process. This exercise is creating their trauma narrative.
The trauma narrative is the client’s telling of the story of their traumatic experience(s). They are often quite difficult to begin, as the emotions engendered by the original trauma can come flooding back as the sufferer recalls the details of the event(s), but it will get easier as the process goes on.
Clients should begin by focusing on the facts – the who, what, when, and where of the experience. Next, they can add the thoughts and feelings that arose during the experience. Once they are comfortable listing or describing their thoughts and feelings during the experience, they should move on to the most difficult or disturbing moments of their trauma. This will be difficult, but it is necessary to put together a comprehensive narrative of the trauma. Finally, the client should take what they have produced so far and wrap it all up and create a seamless narrative, in addition to adding a final paragraph about how they feel now, what they have learned, and if they have grown from the experience.
This exercise can be completed individually or with a therapist or counselor to guide the client through the difficult process. However the narrative is completed, the therapist should go over the exercise with the client once the narrative is finished (Therapist Aid, n.d.).
2. Feel – Exposure
As the name of the main technique used in this step suggests, this is where the client is exposed to the traumatic memory in order to connect the fragmented cognitive and emotional aspects and facilitate catharsis. Imaginal exposure therapy is applied in this step, in which the client reads his or her trauma narrative and the therapist guides the client through processing of the event.
The therapist will then help the client explore their emotional responses and themes that came up during processing, discussing the primary feelings associated with the trauma.
After the session, the client has some homework – he or she will go home and set some time aside each day to process through the traumatic experience, focusing on purging the emotional aspects of it. It will likely be emotionally challenging to dredge up these memories and tie some intense feelings to them, but that is where these emotions belong: with the traumatic experience that spawned them, rather than displaced onto the self or others.
3. Heal – Three Concepts and PTG Channeling
In step three, the focus is on helping the client put the pieces back together, but in a new and stronger configuration than before.
The therapist will emphasize three concepts to the client:
- Freedom of choice – The therapist explains that, while the client did not choose to experience the trauma that led them here, they are in control of their choices going forward. The narrative therapy concept of “rewriting the ending” is discussed to help the client see that he or she can create their own path.
- Finding meaning from the experience – The therapist discusses how the client can find meaning in their experience, however, is appropriate and feasible for them.
- The Hero archetype – Finally, the therapist walks the client through the transformative journey of the Hero archetype by telling stories, tying the client’s spiritual and cultural beliefs into the stories to make them more meaningful for the client. The client may benefit from hearing the many stories in which the hero undergoes significant trauma and becomes a better, stronger person from it.
Once these three concepts are discussed, the therapist can move on to teaching the client techniques from solution-focused therapy, a type of therapy that emphasizes goal-setting and goal-striving. This component is referred to as PTG channeling, as it focuses on the client channeling their emotional energy from reliving or avoiding the traumatic experience into productive, goal-oriented behavior.
Overall, this step is about the client extracting meaning from their experience and finding their own answers and solutions. The therapist may assign more homework as this step wraps up, instructing the client to go home and engage in one action that illustrates their shift from victimhood to posttraumatic growth.
4. Seal – The Mind as a Filing Cabinet
The final step of the PTGP involves tying up loose ends and putting the finishing touches on the reorganization of the traumatic memory.
The “mind as a filing cabinet” metaphor is a great one to use in this step. In this metaphor, the memory of the traumatic experience is likened to a file that is unorganized, scattered throughout the filing cabinet that is the mind. Instead of each component being neatly sorted with the others, they are separated into dozens of different folders with no rhyme or reason, making it confusing and potentially disruptive when one of them is inspected.
In the previous three steps, these components were identified, hunted down, and moved to the right folder, while a few new pages were added documenting the growth experienced through the process. This step finalizes the folder and files it away in the cabinet. It can be revisited in the future, but it is no longer anything more than another in the hundreds and thousands of files and folders that make up the cabinet.
At this point, the client is ready to move on to another disorganized file, if there is another file that is in need of reorganization. Whether the therapy will continue on to another file or not, the therapist should commend the client for all of his or her hard work over the course of therapy and encourage them to continue incorporating PTGP into his or her life. The client should leave feeling empowered over their trauma and ready to move forward with a new and improved perspective on life (Nelson, 2011).
9 Post-Traumatic Growth Worksheets (PDF)
If you or your clients are more hands-on learners, people who like to jump in with both feet, roll their sleeves up, and get to work, you may find the do-it-yourself nature of worksheets and handouts to be particularly helpful.
The following six worksheets are some of the most popular and most promising worksheets and handouts for those suffering from PTSD, especially for those who want to focus on posttraumatic growth, or thrive instead of just survive.
1. Self-Compassion Scale
Happiness begins with self. A crucial part of post-traumatic growth lies in the way we look at ourselves.
The self-compassion scale by Dr. Kristen Neff is helpful for trauma survivors and distressed individuals to help them practice self-love and compassion.
The exercise comes as a self-scorable worksheet consisting of 26 statements that describe our feelings and actions. The responses are scored on a 5-point Likert Scale; the summation of the scores indicate how compassionately we treat ourselves.
Here is a brief overview of the scale. You can also find the full version in our Positive Psychology Toolkit.
2. Radical Acceptance Worksheet
PTG is about accepting the present and moving on without trying to change it. While it may seem hard, survivors agree that letting go is the best way they could overcome the stress.
Through the radical acceptance or distress tolerance worksheet, we can target unconditional self-acceptance and commit to loving ourselves after all the struggles and failures in life. The sheet consists of seven questions, and the responses to each indicate where we lie in terms of self-acceptance.
Here is an illustration of the worksheet:
|Radical Acceptance Worksheet|
|What is upsetting to you at the moment? How did this situation occur? What impact did it have on you?|
|Did your behavior contribute to the situation? If yes, how?|
|How do you think others around you contribute to the situation?|
|Did you have any control over the situation? If yes, how?|
|How did you react to the situation at first?|
|How did your reaction affect others around you?|
|How can you handle a similar upsetting situation in the future?|
3. Exploring Trauma Worksheet
Trauma often acts as triggers to depression and other psychological conditions. The emotional turmoil often makes it difficult for us to rule out where precisely the breakdown started.
The Exploring Trauma Worksheet works best for people who have experienced multiple traumatic events in life. It allows a reasonable understanding of the root cause, thereby making the positive transformation more spontaneous and comfortable.
The worksheet is simple and includes subjective questions, as shown below (Hunter, 2011).
|Exploring Trauma Worksheet|
|Can you identify three events in your life that caused significant distress? How did it happen, and who do you blame for it?|
|From the above three incidents, choose anyone and name three feelings that you felt during that time.|
|How did you cope with the stress? Do you think it worked? Are you over it?|
|Has the experience changed your life? If yes, how?|
|If you could go back and say something to your traumatized self, what would it be?|
The Feeling Thermometer
A handout from Dr. Aureen P. Wagner offers therapists and clients a quick and easy guide to discussing how the client is handling their emotions, specifically those related to the traumatic incident.
It is a simple, one-page handout with an image of a thermometer and ten possible levels:
- Piece of cake!
- A little twinge.
- Just a little uneasy.
- Starting to bother.
- Not too good.
- Getting tough.
- Pretty tough.
- Really tough.
- Can’t handle it.
- Out of control! Ballistic!
This is an excellent place to start any therapy sessions, and it can be extremely helpful when walking a client through an experience that is difficult to talk about.
Post Traumatic Growth Inventory
The Post Traumatic Growth Inventory, or PTGI, was developed by posttraumatic growth researchers Tedeschi and Calhoun as a way to assess the changes that a trauma survivor may have experienced since the event.
It includes 21 statements on potential areas of growth and change, rated on a scale from 0 (I did not experience this change as a result of my crisis) to 5 (I experienced this change to a very great degree as a result of my crisis).
Statements are categorized into the five factors or five areas in which PTG is most often observed.
The first factor in the PTGI is Relating to Others and includes statements like:
- I have a greater sense of closeness with others.
- I am more willing to express my emotions.
- I have more compassion for others.
Factor Two is New Possibilities, with statements such as:
- I developed new interests.
- I established a new path for my life.
- I am more likely to try to change things which need changing.
The third factor is termed Personal Strength and assesses change with statements like:
- I have a greater feeling of self-reliance.
- I am better able to accept the way things work out.
- I discovered that I’m stronger than I thought I was.
Spiritual Change, the fourth factor, is composed of only one or two statements, depending on the client’s beliefs:
- I have a better understanding of spiritual matters.
- I have a stronger religious faith.
The final factor, Appreciation of Life, is characterized by the following statements:
- I changed my priorities about what is important in life.
- I have a greater appreciation for the value of my own life.
- I can better appreciate each day.
You can read more about this scale at this link.
Task Planning and Achievement Record
This exercise has a wide range of applications and can be a beneficial tool for just about anyone, but it may be especially helpful for encouraging clients to work on setting and striving for goals in the Heal step of the PTGP.
It is a very simple worksheet, with only two components. In the first column, the client is to list the task or goal they would like to achieve or accomplish. In the second through eighth columns, the days of the week are listed (i.e., Monday through Sunday).
For each day that the client completes the task or reaches their goal, they can record their success in the corresponding column.
If desired, they can also add more information, such as their rating of their distress at the time, their current mood, or an objective measure of their performance, like runtime or score on an assessment.
This one-page handout is a great complement to the practice of EMDR therapy. It can be used to guide clients into identifying and understanding their thoughts about the traumatic event(s) and how it affected the way they think about themselves.
On one side of the handout is a list of negative cognitions in four separate categories:
- Safety / Vulnerability
- Control / Choice
Under each category, several cognitions or thoughts are listed that a victim of trauma may encounter, such as:
o I am worthless.
o I should have done something.
- Safety / Vulnerability
o It is not okay to feel or show my emotions.
- Control / Choice
o I am not in control.
On the right side of the handout, the positive, opposite cognitions are listed. For example, the opposites of the statements above are:
- I am worthless. / I have value.
- I should have done something. / I did the best I could.
- It is not okay to feel or show my emotions. / I can safely feel and show my emotions.
- I am not in control. / I am in control now.
A therapist can use this worksheet to let clients know their thoughts about the trauma they experienced are not abnormal, but that they can and should work their way from the thoughts on the left to the thoughts on the right.
Patient Imaginal Exposure Data Form
This worksheet can be incorporated into the Feel step of the PTGP when the therapist is walking the client through imaginal exposure. The client may find it helpful to record their distress before, during, and after the imaginal exposure process.
The worksheet instructs the client to record their Subjective Units of Distress Scale or SUDS, level immediately before and after experiencing imaginal exposure. The scale is from 0 (no distress) to 100 (extreme distress). The client is also given an opportunity to record their craving for a harmful substance on a scale from 0 (no craving) to 100 (extreme craving) if that is something they are struggling with.
On the left side of the worksheet, there is space for the client to record the date of their imaginal exposure session. On the right, there are three sections to record their SUDS and/or craving ratings:
- Highest During (or Peak)
Recording these ratings can help clients note any progress they are making in reducing their distress or cravings, and help them find patterns if they are stuck.
You can view this worksheet at this link.
Overcoming Avoidance: Facing Your Fears
Getting over the tendency to avoid situations, people, places, and even thoughts that remind the client of the trauma is a very important step in overcoming trauma and growing from the experience.
This worksheet from Carol Vivyan can help the client identify their avoidant tendencies and come up with a plan to reduce their avoidant behavior.
First, the worksheet includes space for the client to write down anything that he or she fears and actively avoids, including situations; people; places; tv, radio, or internet sources; and thoughts, along with a distress rating on a scale from 0 (least feared or distressing) to 10 (most feared or distressing).
Next, the client is instructed to rewrite the list, only this time including the most feared or distressing item at the top of the list and the least feared or distressing item at the bottom of the list.
Once the list is organized, the worksheet directs the client to think about the least feared or distressing item and come up with ideas for how to start facing it. It may help to break it down into smaller steps. The client should write down what comes to mind, including any smaller steps they have decided on, along with any coping strategies they may use while facing this fear.
A table is included for the client to use in this step, with three columns:
- Feared situation
- Steps I need to take to face the feared situation
- Coping strategies I can use during the feared situation
Once the client has successfully completed this step for her or his least feared situation, the client should continue on for each item on the list. The process should begin with the least feared situation, then the second least feared situation, all the way up to the most feared situation.
To see this worksheet, click here.
A Take Home Message
This piece about positive trauma therapy outlined the symptoms and provided the facts about posttraumatic stress disorder (PTSD), identified some of the most successful methods for treating PTSD, and introduced the concept of posttraumatic growth (PTG), or recovering from trauma to find yourself at a new and improved baseline.
I hope you found this piece to be useful, and I hope it inspired you to believe in your own vast growth potential. No one looks forward to suffering, but in this life, it is inevitable that you will experience suffering at some point. When you do find yourself struggling with trauma, grief, or pain, remember that you have the strength to not only overcome the obstacles in front of you but to become a better and more purpose-driven person as a result.
What do you think about PTG? Do you believe that “what doesn’t kill you makes you stronger?” Have you tried any of these positive trauma therapy tools or techniques? Let us know in the comments!
Thank you for reading!
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