1. health and fitness
2. disorders

Morgan Forum Series Presents:
Postvention, It’s About Time!
and
The Fruits of Trauma?
Posttraumatic Growth Among the Suicide Bereaved
Tuesday
March 31, 2015
Northeast Ohio Medical University Education and Wellness Center
4209 State Route 44 Rootstown, OH
AM Session
Frank Campbell, PhD., LCSW, C.T.
Postvention, It’s About Time!
8:00 – 11:45 am
Dr. Edwin Shneidman challenged the membership of the American Association of
Suicidology over forty years ago to consider how postvention following a suicide
could also be prevention. By shortening the elapsed time between deaths by
suicide and finding the services needed, many are overcoming the dangers
associated with sudden and traumatic loss traditionally associated with a longer
time span. Once connected to the support needed, many individuals and families
are coping with this devastating loss sooner and in a safer more effective way.
This presentation will address what is being accomplished toward the goal of
helping those bereaved by suicide at the local, national and international level.
Dr. Campbell will discuss many of the benefits of Active Postvention for
communities who are working to help the newly bereaved know how to find
resources so they are never alone.
PM Session
Melinda Moore, PhD.
The Fruits of Trauma? Posttraumatic Growth Among the Suicide Bereaved
12:45- 4:30 pm
Posttraumatic Growth (PTG) is a construct of positive psychological change that
occurs as the result of one’s struggle with a highly challenging, stressful, and
traumatic event. PTG can manifest itself in various ways, including increased
appreciation for life, better interpersonal relationships, changed priorities,
increased sense of personal strength, and a deeper spiritual life. The limited
research on suicide bereavement has focused on the psychopathology of this
loss. Research is beginning to emerge about how people can grow from suicide
loss. Dr. Moore will discuss the several studies she has conducted on
Posttraumatic Growth and suicide loss, where research is heading in this area,
and how PTG has emerged in her life as a suicide survivor.
Register Online Now: www.mcmfdn.org
Frank Campbell, Ph.D.,
LCSW, C.T., is the former
Executive Director of the
Baton Rouge Crisis
intervention Center and the
Crisis Center Foundation in
Louisiana, USA. He is currently Senior
Consultant for Campbell and Associates
Consulting where he consults with
communities on Active Postvention efforts and
Forensic Suicidology cases. It was due to his
more than twenty years of working with those
bereaved by suicide that he introduced his
Active Postvention Model (APM) most
commonly known as the LOSS Team (Local
Outreach to Suicide Survivors). The APM
concept involves a team of first responders
who go to the scene of a suicide and provide
support and referral for those bereaved by the
suicide.
Melinda Moore, Ph.D. is an
Assistant Professor in the
Department of Psychology at
Eastern Kentucky University
(EKU) in Richmond,
Kentucky and a Licensed Psychologist. She
conducts suicide bereavement research at
EKU, as well as maintains an ongoing
collaboration with the Department of Defensefunded Military Suicide Bereavement Study at
the University of Kentucky where she recently
completed a postdoctoral fellowship. Dr.
Moore received her Ph.D. in Clinical
Psychology from The Catholic University of
America in Washington, DC, and served in
various capacities in suicide prevention there
and in Ohio.
There is no cost to attend this event,
but registration is required.
Space is limited!
AM Session
7:15 am Registration/sign-in and continental breakfast
7:55
Welcome and overview of day, Rick Kellar, President, MCMF
8:00
Introductions Melinda Moore, Ph.D. & Frank Campbell, Ph.D., LCSW, C.T.
8:15
Postvention, It’s About Time! Frank Campbell, Ph.D., LCSW, C.T.
11:45
Adjournment
AM Objectives
1) To learn the history of Postvention in Suicidology and the potential for Suicide Prevention in a community
2) To understand how the Active Postvention Model (APM) has been introduced to communities around the world with success &
sustainability
3) To attain a new understanding of how the LOSS Team concept can be a suicide prevention resource in the local community by
proving postvention services in a caring community
PM Session
11:45 am Registration/sign-in for PM session and lunch
12:45 pm Comments by Melinda Moore, Ph.D. & Frank Campbell, Ph.D., LCSW, C.T.
1:00
The Fruits of Trauma? Posttraumatic Growth Among the Suicide Bereaved, Melinda Moore, Ph.D.
3:30
Panel and Dialogue, Frank Campbell, Ph.D., Melinda Moore, Ph.D., Jack Jordan, Ph.D.
4:30
Adjournment
PM Objectives:
1) To learn about the development of the construct of Posttraumatic Growth and its application to a broad range of trauma survivors
2) To understand research conducted on the application of Posttraumatic Growth to the suicide bereaved
3) To attain new skills about facilitating Posttraumatic Growth among the suicide bereaved
Continuing Education
Continuing education credits have been awarded to both the AM/PM sessions (see below).
OhioMHAS Continuing Education Committee is an approved provider of Continuing Education for RNs and LPNs for the Ohio Board of Nursing and has
awarded: AM: 3.5 CE contact hours per OBN003 92-1880CO/ PM: 3.25 CE contact hours per OBN003 92-1881CO
OhioMHAS has been approved as a provider of Continuing Professional Education credit by the Ohio Counselor, Social Work, Marriage and Family
Therapist Board.
AM: 3.5 CPEs have been awarded to Social Workers per RSX088902-2105CO and to Counselors per RCX068915-2089CO
PM: 3.25 CPEs have been awarded to Social Workers per RSX088902-2106CO and to Counselors per RCX068915-2090CO
This program meets the three (3) hour required continuing education that addresses supervision for independent social workers with supervising
status per OAC 4757-9.
This program meets the three (3) hour required continuing education that addresses supervision for professional clinical counselors with
supervising counselor status per OAC 4757-9.
This event is planned in partnership with:
OhioMHAS is approved by OPA-MCE to offer continuing education for Psychologists.
AM: 3.5 MCEs are awarded per 311334820-1276CO/ PM: 3.25 MCEs are awarded per
311334820-1277CO.
OhioMHAS is approved by the Ohio Chemical Dependency Professionals Board to offer
recognized clock hours for chemical dependency counselors and prevention professionals.
AM: The provider approval number is 09-1113-64PVN-R for 3.5 RCHs /PM: The provider
approval number is 09-1113-64PVN-R for 3.25 RCHs.
If you have questions or want to learn more about this workshop, contact:
Victoria Romanda  [email protected]  330-655-1366
Register Online Now: www.mcmfdn.org
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
The Fruits of Trauma?
Posttraumatic Growth
among the
Suicide Bereaved
Melinda Moore, PhD
Margaret Clark Morgan Foundation
March 31, 2015
Public Health in Ohio
•
•
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Health Care Reform
Mental Health Parity
Injury Prevention
Cancer
Influenza
Infant Mortality
Heart Disease/Stroke
Long-term Care
Home Health
May 29, 1996
1
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
What I experienced . . .
•
•
•
•
•
•
•
Abandonment and rejection
Guilt
Feelings of being blamed
Shame and stigma
Professional and personal rejection
Social isolation
Posttraumatic Stress Disorder symptoms
What others experienced . . .
• Abandonment and rejection
(Bailley et al, 1999; Harwood, Hawton,
Hope & Jacoby, 2002; Reed, 1998)
• Guilt
•
•
•
•
(Bailley et al, 1999; Cleiren, 1993; Range, 1998)
Feelings of being blamed (Ross, 1995; Shneidman, 1998)
Shame and stigma (Cleiren et al, 1996; Cvinar, 2005)
Professional and personal rejection (Joiner, 2005)
Social isolation (Dyregrov & Dyregrov, 2008)
• Posttraumatic Stress Disorder symptoms
(Armour, 2006;
Melhem et al, 2004; Murphy et al, 1999)
You never know how strong you are
until being strong is the only choice you
have.
-Bob Marley
2
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
The Problem of Suicide
Statewide advocacy
Ohio Coalition for Suicide
Prevention
• Testified before Ohio Legislature
• Educated and brought together
policy makers, higher education,
law enforcement, mental health,
health care, medicine, clergy
• Suicide Prevention Week
• Remembrance Ceremonies
Ohio’s Suicide Prevention Plan
3
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
National Advocacy
• How do we prevent suicide?
• 1-800-SUICIDE
• What about the people left
behind?
• Survivor of Suicide Support
Services
• Survey of Survivor Groups
Collaborative Assessment and
Management of Suicidality (CAMS)
• Suicide treatment protocol
• Assessment process to
collaboratively understand
suicide drivers
• Treatment planning to
target drivers and develop
healthier skills
• On-going suicide tracking
(Jobes, Moore, & O’Connor, 2007)
What do we know about suicide
bereavement?
• Not a lot
• Methodological
problems
• Cross-sectional
• Small sample sizes
(Jordan & McIntosh, 2012)
4
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Is bereavement after suicide
different?
Survivors experience . . .
• Greater struggle to find meaning
• Greater feelings of guilt, responsibility, and
blame
• Greater feelings of rejection and
abandonment by and anger toward
deceased
(Jordan, 2001)
Difficulties Faced by Survivors
• A prolonged and intense search for the
reason for the suicide (Wagner & Calhoun, 1992)
• A distorted sense of responsibility for the
death and the ability to have prevented the
suicide (Dunn & Morrish-Vidners, 1987)
• Feelings of being blamed for causing the
problems that began the suicidal ideation
(Silverman, Range & Overholser, 1995).
• Increased anxiety, anger and shame
(Cerel, et al. 1999)
“The happiest day in the life of a parent is the day their child is born. After my son’s death in 2010, I’ve allowed his birthday on Feb 12th to be a depressing day for me. I am choosing to change that, and make this a day of happy memories and thoughts. He lived 24 years and he made me proud, made me mad, made me laugh and smile, and made me cry. I’ll never forget his sweet smile and charming personality. I miss him everyday. I buried my son but not his memory. RIP”
‐Mike Donta
5
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Growth from trauma
“Even the helpless victim of a
hopeless situation, facing a fate
he cannot change, may rise
above himself, may grow
beyond himself, and by so
doing change himself . . . turn a
personal tragedy into a triumph”
-Viktor Frankl,
Man’s Search for Meaning
Posttraumatic Growth (PTG)
Positive psychological change experienced
as a result of the struggle with highly
challenging life circumstances
 Shattering “assumptive world”
 Cognitive engagement with event– ruminate over
elements
 Rumination allows for repair and restructuring
Calhoun and Tedeschi (2006)
Resilience
“Adults exposed to an isolated
and potentially highly
disruptive event to maintain
relatively stable, healthy levels
of psychological and
physiological functioning . . .
as well as the capacity for
generative experiences and
positive emotions.”
Bonanno, 2004, pp. 20-21)
6
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
A Complicated Relationship?
Posttraumatic Growth Studies
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•
•
Breast cancer survivors
9/11 survivors
Madrid train bombing survivors
HIV/AIDS patients
Motor vehicle accident survivors
Adolescent cancer survivors
Vietnam POWs
Bereaved parents
Rumination
Brooding
• Intrusive
• Early
• Sense-making
Reflective
• Deliberate
• Later
• Meaning-making
POSTTRAUMATIC GROWTH
7
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Five Factors of Posttraumatic
Growth (PTG)
Posttraumatic Growth of Parent
Survivors of Suicide Study
www.posttraumaticgrowth.com
What MIGHT predict PTG in
suicide bereaved?
Gender
Marital Status
Income
Education
Personality traits
• Neuroticism
• Extraversion
• Openness to
Experience
• Prolonged Grief
• Dispositional
Optimism
• Positive and
Negative Affect
• Rumination
(Brooding/Reflective)
• Resilience
8
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
What predicts PTG?
Resilience predicted Posttraumatic Growth*
RESILIENCE
PTG
*p<.05
Five Factors of Posttraumatic Growth
1) Relating to Others
2) New Possibilities
3) Spiritual Change
4) Personal Strength
5) Appreciation of Life
What predicts PTG factors?
RESILIENCE
Factor One: Relating to
Others
- Increased sense of
closeness to others,
especially significant others
- Greater compassion &
empathy
9
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
What predicts PTG factors?
Factor Two: New Possibilities
OPTIMISM
NEUROTICISM
- New responsibilities
- New relationships
RESILIENCE
Posttraumatic Growth Compared
Author
Moore,
Cerel, &
Jobes
(2015)
Engelkemeyer &
Marwit
(2008)
Cadell &
Sullivan
(2006)
Steel,
Gamblin
& Carr
(2008)
Nishi,
Matsuoka
& Kim
(2010)
Bates,
Trajstman,
& Jackson
(2004)
Sample
Parents
Parents
Bereaved Bereaved
by Suicide (N=111) by
homicide,
accident, &
illness
(M=7 yrs
from
death)
Bereaved
by HIV
(N=176)
Cancer
Patients
(N=120)
Japanese
motor
vehicle
accidents
(MVA)
Survivors
(N=118)
Australian
MVA, violent
crime, &
critical
incidents
(N=129)
PTGI
Mean
46.27
64.66
62.31
51
41.2
44.2
SD
24.83
21.65
24.64
28
22.6
22.7
Does Time Lead to Greater Growth?
(Moore and Drapeau, 2013)
10
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
University of Kentucky Military Suicide
Bereavement Study
Funded by the Military Suicide Research Consortium (MSRC)
•
Random-digit dial survey of 900 veterans and 800
community members in Kentucky plus interviews of 125
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Veterans with suicide and/or other traumatic death exposure
Community members with suicide exposure
Interviews with family members of active duty service members
who died by suicide
How many individuals are exposed to suicide?
What are the outcomes of exposure to suicide for
veterans, community members, and those family
members of service members who have died by suicide?
*This work was in part supported by the Military Suicide Research Consortium (MSRC), Department of Defense, and VISN 19 Mental
Illness Research, Education, and Clinical Center (MIRECC), but does not necessarily represent the views of the Department of
Defense, Department of Veterans Affairs, or the United States Government. Support from the MSRC does not necessarily constitute
or imply endorsement, sponsorship, or favoring of the study design, analysis, or recommendations.
Do you know anyone who has
ever died by suicide?
50
45
40
35
30
25
20
15
10
5
0
47.2
47.2
47.1
Total
Community
Veteran
11
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Exposure Related to
Depression & Anxiety
10.7
Anxiety
18.9
Suicide
Unexposed
Suicide
Exposed
10.3
Depression
19.4
0
10
20
30
• Those exposed to suicide are more likely to have anxiety & depression
diagnoses and suicidal ideation
Symptoms not related to
relationship-type
136 Relationship types
• 10.3% first degree
relatives (n=84)
• 23.1% second
degree relatives
(n=188)
• 66.5% nonrelatives (n=541)
12
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Closeness Associated with Mental Health
Symptoms among Suicide Exposed
Low Closeness (1-3)
40
High Closeness (4-5)
34.1
35
30
26.8
25
20
*11
15
10
*
5
6.3
2.2
0
0
Depression
* p<.001
PTSD
Prolonged Grief
University of Kentucky
Military Suicide Bereavement Study
Posttraumatic Growth
“You can come out of it a better person . . . I know
that I am so much more compassionate than ever”
- Linda, mother of “Matt”
“(Through me) Cody is touching so many lives “
- Liz, mother of active duty service member
Linda, mother of “Matt”
• “I knew then that something that came out of it
was going to be positive . . . We are going to do
something . . .”
• “We have fewer friends than we had before, but
we have some *very* good friends and family”
• “I feel honored . . . God gave me that wonderful
young man for 20 years . . .”
• “I don’t waste time on people, things that are not
going to be productive or fun . . . Being upset
that someone is not who you want them to be”
13
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
PTG mean scores
• Veterans with suicide exposure
60+ High
Range
(x=62; sd=32)
• Veterans with traumatic death exposure
(x=61.9; sd=31)
• Veterans with SE + TDE
40+
(x=55; sd=30)
Medium
• Community suicide exposed
Range
(x=57; sd=29)
Posttraumatic Growth Factors
• New Possibilities
–
–
–
–
–
N=95
Mean = 57.91; sd=30.42
I developed new interests
I established a new path for my life
I’m able to do better things with my life
New opportunities are available
I’m more likely to try to change things which need changing
• Personal Strength
– Knowing I can handle difficulties
– Being able to accept the way things work out
– I discovered that I’m stronger than I thought I was
New Possibilities
Positive association with PTSD
POSTTRAUMATIC
STRESS DISORDER
POSTTRAUMATIC GROWTH
14
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Personal Strength
• Positive association with PTSD
• Positive association with Prolonged Grief
PROLONGED
GRIEF
POSTTRAUMATIC GROWTH
Posttraumatic Growth in my own life
RELATING TO OTHERS
NEW POSSIBILITIES
15
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
PERSONAL STRENGTH
SPIRITUAL CHANGE
APPRECIATION OF LIFE
16
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Kristen Spexarth
In the wake of my eldest son’s
suicide my world collapsed and
I experienced a radical
discontinuity. Nothing was solid
and I felt like a puff of wind
being blown about by the
slightest input. Energy coursed
through my body making
movement difficult and my
senses were heightened to
such a degree that even simple
things, like going to the grocery,
were alarming.
- Kristen Spexarth
Kristen Spexarth
As my son wrote in his
last note, “Life is so
beautiful in its triumphs
and tragedies.
Everywhere I look I see
it now. There is beauty
even in fear and pain
but visible only to those
deeply submerged in it.”
- Colby Spexarth
17
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Posttraumatic Growth
“After losing Colby, feeling cut off from
everyone was terrifying, but the strange new
world I found myself in was profoundly
beautiful. Not only was it impossible to distract
myself away from it, I had no desire to do so
for it was more vital and real than anything I’d
ever experienced.”
www.passingreflections.com
Posttraumatic Growth
This is the paradox that is woven
through the wholeness that is
life/death, where the most horrific
of experiences can lead us to
growth and new understanding.
No one longs for loss but finding
ourselves there, it is possible to
find wisdom and greater
awareness from a new
perspective.
- Kristen
Spexarth
Working with the
Bereaved to Facilitate
Posttraumatic Growth
18
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Factor I: Relating to Others
•
•
•
•
•
•
f. Knowing that I can count on people in times of trouble
h. A sense of closeness with others
i. A willingness to express my emotions
o. Having compassion for others
p. Putting effort into my relationships
t. I learned a great deal about how wonderful
people are.
• u. I accept needing others
19
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Factor II: New Possibilities
•
•
•
•
c. I developed new interests
g. I established a new path for my life
k. I’m able to do better things with my life
n. New opportunities are available which wouldn’t have
been otherwise
• q. I’m more likely to try to change things which need
changing
Factor III: Personal Strength
•
•
•
•
d. A feeling of self-reliance
j. Knowing I can handle difficulties
l. being able to accept the way things work out
s. I discovered that I am stronger than I thought I was
Factor IV: Spiritual Change
• e. a better understanding of spiritual matters
• r. I have a stronger religious faith
20
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Factor V: Appreciation of Life
• a. My priorities about what is important in life
• b. An appreciation for the value of my own life
• m. Appreciating each day
Three Conceptual Categories
• A changed sense of oneself
• A changed sense of relationships with others
• A changed philosophy of life
A Changed Sense of Self
• Unambiguous awareness that life holds the potential for
the unexpected and uncontrollable
• “I am much stronger than I ever imagined. If I am living
through this I can live through just about anything.”
• “ I had to deal with major suffering and little things don’t
get to me anymore”
• MORE VULNERABLE, YET STRONGER
21
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Changed Relationships
• “You find out who your real friends are.”
• Deepening and strengthening of relationships
– “I don’t think I have ever been as close to my children as I
have in the months since Harold died. I’ve gotten to know
them in a way that somehow just didn’t seem possible
before. I think I’m more real and so are they . . .”
• Greater freedom to express oneself
– “I feel much freer to express my emotions now, because I
went through a time when I couldn’t hold them back
anyway. And now I like it that I can let them flow with
people I trust.”
– Greater compassion for others who have faced suffering
A Changed Philosophy of Life
• Greater Appreciation of Life
• Strong reminders of mortality:
• What we love is temporary and we must deliberately
engage with the important parts of life while we can
• “After my first cancer, even the smallest joys in life took
on special meaning – watching a beautiful sunset, a
hug from a child, a laugh with Dorothy. After my second
and third cancers, the simple joys of life are
everywhere and are boundless.” – Hamilton Jordan
• Metaphorical “thin places” creating a crisis of faith or
existential crisis
Caveat to Clinicians
• Posttraumatic growth is common, but may not be
universal
• 30% to 90% of persons dealing with major difficulties
will signal some element of growth
• Posttraumatic growth is not necessarily an
experience that leads people to feel less pain from
tragedies they have experienced, nor does it
necessarily lead to an increase in positive emotions.
• Growth and Distress are separate dimensions.
Increased growth can contribute to recognition of
what is important in living well and more fully, but
may not contribute to a subjective sense of
cheerfulness.
22
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Posttraumatic growth
in clinical practice
• Understanding trauma
as a precursor to growth
• Emotion regulation and
PTG
• Self-disclosure and
reconstructing
relationships
• Creating a narrative with
PTG domains
Tips for clinicians
• Consider the social and cultural context of the bereaved:
– Culture of the family, community, and larger
geographic region
– What are the commonly held beliefs about suicide?
– Must understand a client’s world view and belief system
• What are the availability of growth themes through the
existence of proximate and distal culture?
• What is one’s understanding of growth and how is it
modeled and reinforced?
• How is one’s understanding of growth reinforced or
sanctioned?
• Who are their supportive others?
• How long are they supportive?
Facilitating PTG through Expert
Companionship
• Companions who help nurture naturally occurring processes
of healing and growth
• Companions who lead with companionship, rather than
technical expertise or knowledge
• Journey with and “learning from” the bereaved
• Helping to rebuild a “world view” with a hopeful stance for
the future
– Free of distressing symptoms
– Life possible without revictimization
– How meaning and purpose are still possible
• Must accurately understand a client’s internal world
(empathy)
23
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Expert Companionship
• Revision of the life narrative is co-authored by
the trauma survivor and the expert companion
• Survivor benefits from expert companionship in
narrative reconstruction because it is hard to
appreciate oneself from an internal point of view
• Expert companion notices things that the trauma
survivor overlooks:
“Given how horrible this event was, is there
any possibility of anything valuable coming
from it?”
Central components of facilitating growth
•
•
•
•
Focus on listening
Notice growth if the client approaches it
Label it if growth is there
Inquire about the possibility
– follow their lead as they describe
experiences
• Choose the right words
– Characterize growth from their “struggle” not
the event itself
Specific Approaches
•
•
•
•
Mindfulness Meditation
Walks in Nature
Therapy
Journaling
24
The Fruits of Trauma? Posttraumatic
Growth among the Suicide Bereaved Melinda Moore, Ph.D.
March 31, 2015
Narrative Reconstruction
• Narrative that incorporates the traumatic experience and
allows for recognition of the positive changes in the aftermath
• Integrating one of the five domains into their new narrative
• Ability to link together a story that provides a sense of self –
“autobiographical reasoning”
• Creating a timeline of their life of both positive and negative
events
• Recognition of the life pre-trauma – what are they changing
“from”
• Recognition that they have suffered other major stressors
• “How did going through all of this change you?”
• Listen for PTG, healthy coping and new core beliefs.
Thank You!
Melinda Moore, Ph.D.
[email protected]
25
Post Traumatic Growth Inventory
Indicate for each of the statements below the degree to which this change occurred in
your life as a result of your crisis [researchers may enter a particular crisis event here],
using the following scale.
0= I did not experience this change as a result of my crisis.
1= I experienced this change to a very small degree as a result of my crisis.
2= I experienced this change to a small degree as a result of my crisis.
3= I experienced this change to a moderate degree as a result of my crisis.
4= I experienced this change to a great degree as a result of my crisis.
5= I experienced this change to a very great degree as a result of my crisis.
1. I changed my priorities about what is important in life. (V)
2. I have a greater appreciation for the value of my own life. (V)
3. I developed new interests. (II)
4. I have a greater feeling of self-reliance. (III)
5. I have a better understanding of spiritual matters. (IV)
6. I more clearly see that I can count on people in times of trouble. (I)
7. I established a new path for my life. (II)
8. I have a greater sense of closeness with others. (I)
9. I am more willing to express my emotions. (I)
10. I know better that I can handle difficulties. (III)
11. I am able to do better things with my life. (II)
12. I am better able to accept the way things work out. (III)
13. I can better appreciate each day. (V)
14. New opportunities are available which wouldn't have been otherwise. (II)
15. I have more compassion for others. (I)
16. I put more effort into my relationships. (I)
17. I am more likely to try to change things which need changing. (II)
18. I have a stronger religious faith. (IV)
19. I discovered that I'm stronger than I thought I was. (III)
20. I learned a great deal about how wonderful people are. (I)
21. I better accept needing others. (I)
Note: Scale is scored by adding all responses. Factors are scored by adding responses to
items on factors.
PTGI Factors
Factor I: Relating to Others
Factor II: New Possibilities
Factor III: Personal Strength
Factor IV: Spiritual Change
Factor V: Appreciation of Life
post-traum atic grow th inventory
Listed below are 21 areas that are sometimes reported to have changed after traumatic
events. Please mark the appropriate box beside each description indicating how much you
feel you have experienced change in the area described. The 0 to 5 scale is as follows:
0 = I did not experience this change as a result of my crisis
1 = I experienced this change to a very small degree
2 = a small degree
3 = a moderate degree
4 = a great degree
5 = a very great degree as a result of my crisis
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.
t.
u.
possible areas of grow th and change
my priorities about what is important in life
an appreciation for the value of my own life
I developed new interests
a feeling of self-reliance
a better understanding of spiritual matters
knowing that I can count on people in times of trouble
I established a new path for my life
a sense of closeness with others
a willingness to express my emotions
knowing I can handle difficulties
I’m able to do better things with my life
being able to accept the way things work out
appreciating each day
new opportunities are available which wouldn’t
have been otherwise
having compassion for others
putting effort into my relationships
I’m more likely to try to change things which need changing
I have a stronger religious faith
I discovered that I am stronger than I thought I was
I learned a great deal about how wonderful people are
I accept needing others
0 1 2 3 4 5
Tedeschi RG & Calhoun LG The posttraumatic growth inventory: measuring the positive legacy
of trauma Journal of Traumatic Stress 1996; 9: 455-471
ptgi: background
introduction: The Posttraumatic Growth Inventory (PTGI) was developed by Richard Tedeschi
and Lawrence Calhoun at the University of North Carolina. Their website provides useful
resources and background information. See http://ptgi.uncc.edu/index.htm. They write “The
Posttraumatic Growth Inventory … has now been used in many investigations in the United States
and in other countries throughout the world. There is no charge for the use of the scale, provided
the scale is being used for research purposes and financial gain does not occur from its use.”
The description below is taken from their website’s brief overview of posttraumatic growth.
w hat is posttraum atic grow th? It is positive change experienced as a result of the
struggle with a major life crisis or a traumatic event. Although we coined the term posttraumatic
growth, the idea that human beings can be changed by their encounters with life challenges,
sometimes in radically positive ways, is not new. The theme is present in ancient spiritual and
religious traditions, literature, and philosophy. What is reasonably new is the systematic study of
this phenomenon by psychologists, social workers, counselors, and scholars in other traditions of
clinical practice and scientific investigation.
w hat form s does posttraum atic grow th take? Posttraumatic growth tends to occur in
five general areas. Sometimes people who must face major life crises develop a sense that new
opportunities have emerged from the struggle, opening up possibilities that were not present
before. A second area is a change in relationships with others. Some people experience closer
relationships with some specific people, and they can also experience an increased sense of
connection to others who suffer. A third area of possible change is an increased sense of one’s
own strength – “if I lived through that, I can face anything”. A fourth aspect of posttraumatic
growth experienced by some people is a greater appreciation for life in general. The fifth area
involves the spiritual or religious domain. Some individuals experience a deepening of their spiritual lives, however, this deepening can also involve a significant change in one’s belief system.
som e clarifications
Most of us, when we face very difficult losses or great suffering, will have a variety of highly
distressing psychological reactions. Just because individuals experience grow th does not
m ean that they w ill not suffer. Distress is typical when we face traumatic events.
W e m ost definitely are not im plying that traum atic events are good – they are not. But
for many of us, life crises are inevitable and we are not given the choice between suffering and
growth on the one hand, and no suffering and no change, on the other.
P osttraum atic grow th is not universal. It is not uncommon, but neither does everybody who
faces a traumatic event experience growth.
Our hope is that you never face a m ajor loss or crisis, but most of us eventually do, and
perhaps you may also experience an encounter with posttraumatic growth.