Thriving—Beyond Surviving: Resiliency After Trauma
By Shelley A. Wiechman, PhD
"You will never know how strong you are until being strong is the only choice you have." —Bob Marley
I was trained as a sport psychologist and worked as a sport psychologist for collegiate and professional athletes for many years before joining a burn unit team. I had done an internship at a burn unit and was amazed at the power of the human spirit in coming through adversity. I wanted to shift focus and try to use some of the same performance enhancement skills that I taught to elite athletes who were vying for a peak performance to help burn survivors to have a peak performance of their own: thriving after a burn injury.
As I immersed myself into the literature on burn injuries, I was struck by a key difference between the research on elite athletes and those of burn survivors:
As a sport psychology clinician and researcher, we studied the athletes who consistently had a peak performance, whether it was in practice or the championship game. They could perform under pressure and, in fact, seemed to thrive with pressure. We studied what it meant to be “mentally tough” and what characteristics the mentally tough athlete possessed.
Characteristics of Mentally Tough Performers
- Cope more easily with setbacks
- Have control over anxiety and use it productively
- Have higher self-confidence
- Use more positive self-talk
- Have a positive outlook on the future
- Set specific goals and visualize accomplishing goals
- Have a support network
Our goal was to identify those characteristics so that we could teach others.
In the field of burns, I noticed that we researched and reported on the challenges that burn survivors face—the prevalence of posttraumatic stress disorder, depression, and social anxiety—and how to treat those disorders. We focused on a deficit model of functioning.
Don’t get me wrong, I think those issues are incredibly important and, in fact, my own research has focused on those issues. But the reality is that the majority of people who experience stressful or traumatic life events do not develop long-term distress, and, in fact, report a return to their baseline level of functioning and even report growth in the face of adversity. The consequence of such a strong focus on a deficit model is that we have gotten away from studying the factors that define resiliency after a trauma. We have not highlighted the potential for posttraumatic growth and given equal attention to those who thrive in the face of adversity. Fortunately, burn survivors have taken this topic up on their own and are showing us every day how to thrive under pressure, not just survive.
What Is Resiliency and Posttraumatic Growth?
Resiliency is defined as the ability to bounce back from negative emotional experiences. It is the flexible adaptation to the changing demands of stressful experiences. Resilient people tend to be optimistic, energetic, curious, open to new experiences; show high positive emotionality; and elicit positive emotions through humor and relaxation. These characteristics are similar to those that define mental toughness. Some argue that resilient individuals maintain a relatively stable level of functioning with only transient experiences of distress after trauma (Bonnano, 2004).
Posttraumatic growth is defined as a positive psychological change experienced as a result of the struggle with highly challenging life circumstances (Tedeschi and Calhoun, 1996). It is important to note that posttraumatic growth and resiliency are distinct concepts. The presence of resiliency seems to be a predictor of posttraumatic growth.
Steps to Building Resiliency
Although there has been some debate, most clinicians believe that resiliency can be taught. Here are some practices that you may find helpful:
Adopt an active coping style. Active coping, such as problem- focused coping and reinterpretation consistently appear as strong correlates to post-traumatic growth and seem to be more effective than passive coping styles. Cognitive processing that focuses on an individual’s struggle to make sense of the trauma and the creation of a new worldview is an important part of active coping.
Work toward acceptance. In the control-coping literature, it is generally believed that acceptance coping leads to better outcomes in situations where the person has no control over the event or environment. Those who can accept that the traumatic event happened and that it cannot be changed can then focus their energy on what they can control.
Surround yourself with positive social support. This support can be from family, friends, and even strangers in a support network.
Foster spirituality. People who have intrinsic spiritual beliefs and who attend religious gatherings tend to experience more resiliency and growth. The social support that they receive from others who share similar beliefs is quite helpful in the face of a trauma. Spiritual beliefs can also help an individual restructure their worldview in a way that makes sense to them.
Acknowledge three blessings. Engage in writing down three blessings daily as described by Alicia Assad in the previous issue of Burn Support Magazine (Issue 2, 2015). This exercise will help you to stay focused on the positive.
Engage in daily positive imagery. Set some future goals and visualize yourself accomplishing them.
Practice positive self-talk. Keep track of your self-talk and stick to the magic 5:2 ratio—for every 2 negative thoughts, have 5 positive thoughts.
Find inspiration. Put together a playlist of inspirational songs that you can pull out when you need a boost. Watch some of the classic movies of inspirational human performance to inspire you. Here is my list to get you started, but add whatever is inspirational to you:
• Hoosiers • The Blue Angels (documentary)
• Field of Dreams • Rudy
• Chariots of Fire • Miracle
• Rocky • The Right Stuff
• A League of Their Own • Apollo 13
(While many inspirational movies show the hero conquering adversity, note that it’s not always a smooth road.)
Building Resiliency in Children
Kids are naturally resilient and can be a role model for us all. Parents can take steps to continue to foster that resiliency after a trauma by avoiding the urge to overprotect the child. It is normal for parents to want to save their children from negative feelings or challenges. Instead, let them have those feelings. Parents can build their children’s resiliency by giving them the message that they are confident that they will get through this tough time and love them enough to let them experience it fully. If children are always rescued from discomfort and frustration, they will believe they are not able to handle those emotions or challenges.
Acknowledging Your Own Achievements
Although researchers and clinicians have taken several decades to focus on the issue of resiliency and posttraumatic growth, burn survivors have figured it out for themselves. Thriving in the face of adversity is what maintains the human spirit and promotes the incredible resiliency of the human nature. Take pride in knowing that you are achieving your own peak performance and inspiring those around you. Most of us will never know how we would respond in the face of adversity. You know. And you should be proud.
“I don’t want to just survive, I want to thrive” —Inspirational burn thriver
Bonanno GA. Loss, trauma and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol. 2004:59:20-28.
Tedeschi R, Calhoun LG. Trauma and Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, CA: Sage Publications; 1995.
Wiechman-Askay S, Magyar-Russell G. Post-traumatic growth and spirituality in burn recovery. Int Rev Psychiatry. 2009;21:570-579.
Wiechman S, Friedlander L. Help Your Child Recover—Build Your Child’s Resilience After Burn Injury (fact sheet). National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Injury Model Systems. 2014. Available at: http://www.msktc.org/burn/factsheets/Build-Childs-Resilience-After-Burn-Injury.
Dr. Shelley Wiechman is an associate professor and the attending psychologist on the Burn and Pediatric Trauma Service and Pediatric Primary Care Clinic at Harborview Medical Center in Seattle. Prior to that, she was a sport psychologist at both the University of Arizona and the University of Washington for 8 years. She continues to consult with elite figure skaters. She also conducts research on the use of hypnosis for pain and itch, as well as long-term adjustment to burn injuries. Dr. Wiechman is board certified in rehabilitation psychology by the American Board of Professional Psychology. She is a member of the American Psychological Association and the American Burn Association, and is a member of the board of trustees with the American Burn Association.