Author: Vivek Banerji, Founder of Insight Dojo
The year is coming to an end, and we’ve been reviewing the ideas that influenced us in 2015. One of the more profound experiences was applying the framework of posttraumatic growth to help healthcare companies design patient support programmes, and presenting our work at the ESOMAR Global Qualitative conference in Paris. What made the experience poignant was that the conference took place in the immediate wake of the terror attack in Paris. The attendees were deeply affected by that traumatic event, and the ideas expressed seemed to have broader relevance. This is a shorter version of our ESOMAR article, the link of which is given at the end of the blog along with other references.
INSPIRATION
Our inspiration for the work was an ex-colleague and friend, Jennifer Goodman Linn, who died of a rare form of cancer four years ago. One of the things that was remarkable about her story was the complete transformation that she went through during her illness. With her husband, David, she started a movement called “cycle for survival” that raised over 75 million dollars for cancer research in the last few years. She also started a motivational training company called “You Fearless” through which she inspired many individuals and groups to overcome their fears and accomplish more. This is an exceptional example of posttraumatic growth.
THE IDEA OF POSTTRAUMATIC GROWTH
The idea of posttraumatic growth is relatively new in the field of positive psychology. According to Tedeschi and Calhoun, who coined the term, “Posttraumatic growth is the experience of positive changes that occur as a result of the struggle with highly challenging life crises.” A lot of research on this topic has been done in the context of events that lead to trauma such as a terror attack, the death of a relative, the divorce of parents, a brutal attack or an illness.Our attempt was to use that general construct to shed light on the possible path to transformation of patients with chronic pain.
APPLICATION TO CHRONIC PAIN
Chronic pain is a traumatic event. The onset often comes as a surprise. The diagnosis is difficult involving patients visiting many doctors without getting clarity about their condition, and feeling misunderstood. The pain is ever present and alters daily activities resulting huge emotional and psychological impact. To exacerbate things further, the side effects of pain relief medication can be really strong.
To understand the experience of pain as a trauma, and the facilitators and barriers for the growth journey for chronic pain sufferers, we conducted ethnographic work in the UK, Spain, Germany and Italy. We supported our primary qualitative work by desk research of academic literature.
THE PROCESS OF GROWTH
There are many intricate details about the process of growth in the literature, but certain aspects that were particularly salient for us are given below:
1. Trauma serves as a wake up call: The sudden feeling of loss, the uncertainty of plans, the constraints on choices, and the fragility of life make one go into an introspective state and re-examine one’s purpose, activities and relationships.
2. Growth is not simply about being resilient or strong: One cannot simply will one’s way into recovery through resisting the strain of an adversity. In fact, people need to experience stress before growth can happen.
3. Deeply held assumptions about oneself are suddenly challenged in the light of the trauma: Stephen Joseph, a leading authority on posttraumatic growth, has used the metaphor of a shattered vase to describe this breakdown of the assumptive world. In reassembling these shattered pieces, new meaning is created.
The following quote from an interviewee in our research, a classical dancer, brings these points to life, “For a classical dancer, the most awful scenario would be not to be able to move as you did before. That was my nightmare and that’s what I had to deal with... I started realizing that I thought I was my wits, I thought I was my physicality…And, all of that kind of left. I had to find my essence. Who was I then? What was my essence if I couldn’t count on those two things? I hadn’t realized that I depended on those two things…I realized that my essence was deeper. Slowly and surely I became grateful.“
In general, growth manifests itself in a variety of ways – better relationships, new careers, a feeling of greater empowerment, but at the heart of it is a connection to a deeper sense of purpose and the prioritisation of one’s life accordingly. For instance, the classical dancer went through an internal transformation, and found that her purpose was to be a positive catalyst in other people’s lives.
We found certain common facilitators of growth that helped us identify ways to strengthen existing patient support programmes.
HOW HEALTHCARE COMPANIES CAN DESIGN BETTER PATIENT PROGRAMMES
Five themes to improve the design of patient support programmes emerged from our exploratory work. By systematically including these aspects, healthcare companies can enable better emotional coping, and tap into the latent potential of patients to grow.
1. Facilitating introspection: Constructing a new narrative and interpreting one’s trauma is a big part of coming to terms with the condition and creating new paths for oneself. Simple tools, such as online journals, to facilitate expression and reflection can help patients better interpret both their daily experience and the bigger changes in their lives.
2. Mind-body exercises: Just about everyone who had experienced growth in our sample had benefitted from participating in activities such as Yoga, Tai Chi, Alexander technique, meditation, chanting or some other form of mind-body practice. These provide relaxation and relief from pain, stimulation due to learning, and most importantly an awareness of the mind and body experiences that bring about a host of changes by reframing one’s view of pain
3. Creating empathetic networks: Those who experienced growth emphasized the role of empathetic people such as other patients, friends and family members, spiritual groups, in facilitating their journey
4. Healing with art: Practising an art form, e.g., playing a musical instrument, drawing and painting, can facilitate the growth process by connecting people to their feelings, allowing expression in non-verbal ways, and in the words of a respondent “provide the joy of creativity”.
5. Having a mentor: Many of the patients had a mentor, a friend, another patient, a teacher or a healthcare professional who listened to them, and provided guidance to move them along their journey.
We will continue to work on posttraumatic growth and more broadly on patient-centricity for healthcare organisations, and would be happy to collaborate with people who are interested.
We hope 2016 is fantastic for you.
Happy New Year!
References and Recommended Reading
Garland, Sheila N., Linda E. Carlson, Sarah Cook, Laura Lansdell, MichaelSpeca. (2007). “A non-randomized comparison of mindfulness-based stress reduction and healing arts programs for facilitating post-traumatic growth and spirituality in cancer outpatients”. Supportive Care in Cancer, 15 (8), 949-961.
Grealy, Madeline and Nanette Mutrie. (2009). “Post-traumatic growth and life threatening physical illness: A systematic review of the qualitative literature”. British Journal of Health Psychology. 14 (2), May, pp.343-378.
Joseph, Stephen. (2013). What Doesn't Kill Us: The New Psychology of Posttraumatic Growth.
Kabat-Zinn , Jon. (2009). Full Catastrophe Living: How to cope with stress, pain and illness using mindfulness meditation.
Tedeschi, Richard G. and Lawrence G. Calhoun. (2004). ‘Posttraumatic Growth: Conceptual Foundations and Empirical Evidence’, Psychological Inquiry: An International Journal for the Advancement of Psychological Theory, 15
https://www.cycleforsurvival.org
