An introduction to:
Positive Psychological Change including
Post Traumatic Growth
David Blore
Accredited CBT, Consultant Accredited EMDR
Doctoral researcher University of Birmingham
Visiting Lecturer Teesside University
Chester & NE Wales BABCP: 8th April 2011
• Please state:
Your name
Your job title/role
Where you work
Why you chose to come to today’s presentation
• Now introduce yourself to any one person in the
• Tell that person…
– Two things you have achieved in the past week
– Two things you are grateful for in the past week
– Two things you appreciate about the person you are
speaking to
– Two personal learning objectives you have for the day
• Feedback
– How well do you know the person you spoke to?
– How easy was it to talk positively?
– What are your personal learning objectives?
Orientation of day
• Everything that follows applies to CBT generically – but EMDR
• The focus will be on psychological trauma (e.g. PTSD). Less
obviously the content is based upon the a priori position that all
mental health disturbance is due to trauma of some form or
• To save space on slides references have been kept to a
minimum but are supplied in hard copy form
Orientation of day:
The appreciation of ‘change’
• Throughout the day we will be referring to 3 types of
psychological ‘change’:
• Negative Psychological Change – on a day to day basis referred
to as ‘symptoms’ (NPC)
• Reduction of NPC – on a day to day basis referred to as “getting
better” (RNPC)
• Positive Psychological Change – frequently called Post
Traumatic Growth (PTG) – is not the same as a reduction of
negative change (PPC)
Orientation of day:
The appreciation of ‘change’
• Please note that PPC is being used as a generic term
to cover all forms of positive change
• The difference between PPC and PTG will become
clear, but PPC is not limited to PTG
Agenda for the day
• Maslow revisited; Aristotle, Hobbes, Rousseau,
Freud, Simon Weston, lessons from history;
introduction to paradox in PPC
– Coffee
• The ‘building blocks’ of PPC
– Lunch
• Exercise in personal understanding of PPC,
Seligman – film: 11th reason to be optimistic
– Tea
• Latest update on research into PPC post RTA, post
EMDR; what positive things have been learnt today?
Maslow’s criticism of the ‘negative only’ (i.e.
NPC) view of mental health
“The science of psychology has been far more successful on the negative
than on the positive side. It has revealed to us much about man’s
shortcomings, his illness, his sins, but little about his potentialities, his
virtues, his achievable aspirations, or his full psychological height. It is
as if psychology has voluntarily restricted itself to only half its rightful
jurisdiction, and that, the darker, meaner half.”
(Maslow 1954 p.354)
• The study of positive outcomes to psychological
trauma is in its infancy (about 12 years old actually)…
• Whilst studies into the negative outcomes of (say)
anxiety and depression, outnumber studies of
positive outcomes by several orders of magnitude…
• …the potential impression is that positive outcomes
are trivial….
• …but has this always been so…?
Lessons from history…
The approach to psychological
trauma in the Western world is
overwhelmingly based on -ve
This is understandable because
of the priority of healthcare to
reduce painful suffering and
stems directly from the medical
model and the laws of tort and
But historically this -ve
perspective is atypical. For most
of recorded history, the
Aristotelian philosophy of
positiveness held sway
Lessons from history…
We have the English Civil War
philosopher Thomas Hobbes
(1588-1679) to thank for
‘psychological egoism’ a deeply
-ve view of human nature…
supremely -ve !
…Hobbes believed that men in
a state of nature, (defined as a
state without civil government),
are in a war against all others in
which life is hardly worth living
Lessons from history…
Within a 100 years of Hobbes,
Jean-Jacques Rousseau (17121778) was supporting the
Aristotelian position by
espousing that humans were
born moral and with the
potential for good
In psychology, both Spencer
(1871-1939) and McDougall
(1820-1903) also tried to
oppose the negative position,
the latter declaring that humans
had an empathic instinct
Lessons from history…
However, Freud belonged to the
Hobbesian school, and declared
in a letter to a colleague in
“I have found little
that is good in human
beings on the whole.
In my experience
most of them are
Lessons from history…
Scheff (1966) warned that a
categorisation such as mental
illness becomes an identity thus
stabilising the role and
reinforcing adoption of the -ve
human view.
All this and DSM as well ! “Sad
to say our theories of therapy
are principally theories of
psychopathology” (Held 1991)
Lessons from history…
So despite efforts to the
contrary, the -ve view remained
the “primary and true
motivation” (Jørgensen &
Nafstad 2004), even accounting
for moral and unselfish
…perhaps altruism was dead
after all!
Maslow’s criticism of the ‘negative only’
view of mental health:
“The science of psychology has been far more successful on the
negative than on the positive side. It has revealed to us much
about man’s shortcomings, his illness, his sins, but little about
his potentialities, his virtues, his achievable aspirations, or his
full psychological height. It is as if psychology has voluntarily
restricted itself to only half its rightful jurisdiction, and that, the
darker, meaner half.”
(Maslow 1954 p.354)
Textual analysis of Maslow’s criticism
So whilst positive = potentialities, virtues, achievable aspirations, and
full psychological height…
Negative = shortcomings, illness, sins, darker, and meanness…
Religion, e.g. Christianity, describes man’s shortcomings, sins,
darkness and meanness and explains that man will die because of
So shortcomings, sins, darkness and meanness = illness and ultimately
death… depressing!
Textual analysis of Maslow’s criticism
Hardly surprising then that in Medieval times those with mental health
problems were seen as “sinners” requiring that demons were “smoked
What would Maslow have said about that!
…but what would those from Medieval times say about Maslow?
More curiously why did those from Medieval times not refer to the
Aristotelian view of health?
We don’t know. Possibly because there was no meaningful conception
of mental health problems so ignorance ‘defaulted’ to religious
Maslow’s hierarchy of needs…
• Lower levels of hierarchy
could be seen as the
‘symptom’ levels
• What about the top level
which constitutes the
individual’s “full
psychological height”?
Lessons from history…
However…Frankl (1963) (top left)
and later Tedeschi & Calhoun
(1995) (bottom pair) (the authors who
coined the term ‘Post Traumatic
Growth’), started to reverse over
300 years of Puritan negativity
‘Positiveness’ broke through
more decisively with the
creation of Positive Psychology
associated most strongly with
Martin Seligman (from 1997
onwards) (top right)
Lessons from history…
This doesn’t mean that we should view
responses to psychological trauma as
either positive or negative, but that both
should be involved to obtain a complete
This dual complimentary approach to
psychological trauma takes us into the
area traditionally occupied (in the East)
by Taoist philosophy in which the ‘whole’
requires a balance of positives and
negatives: known as ying and yang (the
equivalent to the Hippocratean balance
of the 4 humours)
Lessons from history…
Adopting this approach would
lead to identification of dis-ease
by examining the presence of
negative symptomatology and
absence of positive
Feel uncomfortable using the
word symptomatology in this
way? It just shows how closely
associated the word is with
The Taoist DSM
With apologies to:
…a totally different DSM would
ultimately be needed !
An antonym to ‘trauma’?
"Our English language is deficient in some respects. We have the word
'trauma' to denote an unfortunate blow that injures the personality,
but as yet we have no word that describes an experience that is
fortunate, that strengthens the personality.
The closest we come to this is to say it is a blessing, but counting our
blessings does not really meet our need for a word directly opposite
in meaning to 'trauma'."
Margaret Mead 1901-78 Cultural anthropologist
At least 14 names for PPC
Stren conversion (Finkel 1974, 1975)
Drawing strength from adversity (McCrae 1984)
Positive reinterpretation (Scheier et al 1986)
Positive psychological changes (Yalom & Lieberman 1991)
Perceived benefits / construing benefits (e.g. Calhoun & Tedeschi 1991)
Transformational coping (e.g. Aldwin 1994)
Thriving (O’Leary & Ickovics 1995)
Post Traumatic Growth (Tedeschi & Calhoun 1995)
Stress related growth (Park et al 1996)
Discovery of meaning (Bower et al 1998)
Flourishing (Ryff & Singer 1998)
Positive illusions (Taylor & Brown 1998)
Positive emotions (Folkman & Moskowitz 2000)
So what does common sense
(an Aristotelian concept) tell us?
It may be common sense not to
take notice of the media, but the
media does gives us clues…
…what is your opinion of
Simon Weston?
Common Sense tells us he has
been through a traumatic
experience, we read however
that despite suffering, he is
internationally respected – thus
trauma has led paradoxically to
Is PPC really a paradox then ?
Not really, it is our standpoint that is paradoxical
We expect (fervently) one thing to be right……yet it isn’t
We would have expected Simon Weston to have been miserable, to hide
himself away, be depressed and so on…
But he is incredibly cheerful, positive, dynamic and is fervently committed
himself…… to his charities
He has a new role in life, one that without trauma he couldn’t have had
Have you ever wondered why there are so many self help groups?
Learning about PPC through paradox
Loss seems to produce something of value
Vulnerability makes for strength
Traumatic experiences lead to an increased sense of personal
capacities to survive and prevail
Confronting death focuses the mind on living
Traumatic events lead to being more comfortable with intimacy
Learning about PPC through paradox
Previously important things are considered less so, and vice versa
Mortality faced through trauma leads to religious, spiritual and
existential philosophy changes
Shattered philosophies result in more meaningful philosophies
PPC doesn’t necessarily result in less emotional distress…
…the “sadder but wiser” phenomenon
More on paradox later…
Gaining an insight into PPC through:
The media ! (gosh that’s dangerous isn’t it?)
…No! watch programmes about awards for bravery
Self help groups
Studying paradoxes
Be creative with therapy !
A useful working definition of PPC
“…something positively new that signifies a kind of surplus compared to
precrisis level…”
(Zoellner & Maercker 2006)

Introduction to Positive Psychological Change including PTG