1 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: 8 th April 2011

2 Introductions Please state: –Your name –Your job title/role –Where you work –Why you chose to come to today’s presentation

3 EXERCISE 1 Now introduce yourself to any one person in the room… 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

4 EXERCISE 1 Feedback –How well do you know the person you spoke to? –How easy was it to talk positively? –What are your personal learning objectives?

5 Orientation of day Everything that follows applies to CBT generically – but EMDR specifically 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 other To save space on slides references have been kept to a minimum but are supplied in hard copy form

6 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)

7 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

8 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: 11 th reason to be optimistic –Tea Latest update on research into PPC post RTA, post EMDR; what positive things have been learnt today?

9 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)

10 Background 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…?

11 Lessons from history… The approach to psychological trauma in the Western world is overwhelmingly based on -ve symptomatology 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 delict But historically this -ve perspective is atypical. For most of recorded history, the Aristotelian philosophy of positiveness held sway

12 Lessons from history… We have the English Civil War philosopher Thomas Hobbes ( ) 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

13 Lessons from history… Within a 100 years of Hobbes, Jean-Jacques Rousseau ( ) was supporting the Aristotelian position by espousing that humans were born moral and with the potential for good In psychology, both Spencer ( ) and McDougall ( ) also tried to oppose the negative position, the latter declaring that humans had an empathic instinct

14 Lessons from history… However, Freud belonged to the Hobbesian school, and declared in a letter to a colleague in 1918: “I have found little that is good in human beings on the whole. In my experience most of them are trash…”

15 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)

16 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 behaviour… …perhaps altruism was dead after all!

17 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)

18 Textual analysis of Maslow’s criticism So whilst positive = potentialities, virtues, achievable aspirations, and full psychological height… Negative = shortcomings, illness, sins, darker, and meanness… Familiar? Religion, e.g. Christianity, describes man’s shortcomings, sins, darkness and meanness and explains that man will die because of these So shortcomings, sins, darkness and meanness = illness and ultimately death… depressing!

19 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 out” 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 explanations

20 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”?

21 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)

22 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 picture 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)

23 Lessons from history… Adopting this approach would lead to identification of dis-ease by examining the presence of negative symptomatology and absence of positive symptomatology Feel uncomfortable using the word symptomatology in this way? It just shows how closely associated the word is with negativity… …a totally different DSM would ultimately be needed ! The Taoist DSM With apologies to:

24 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 Cultural anthropologist

25 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)

26 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 ‘growth’

27 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?

28 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

29 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…

30 Gaining an insight into PPC through: The media ! (gosh that’s dangerous isn’t it?) …No! watch programmes about awards for bravery Autobiographies Self help groups Studying paradoxes Be creative with therapy !

31 A useful working definition of PPC “…something positively new that signifies a kind of surplus compared to precrisis level…” (Zoellner & Maercker 2006)