The field of clinical psychology has been criticized for emphasizing diagnosis and treatment of psychopathology at the cost of our understanding of psychological health (Sheldon & King, 2001). In an earlier blog, I discussed how we have long recognized that many individuals with disabilities are psychologically healthy. However, despite this history, the focus has been more on the negative consequences and the psychopathological reactions to disability. As a result of the scientific focus on negative psychological functioning and disability, the field knows very little about the majority. That is, those individuals who DO NOT experience significant emotional distress or are psychologically healthy in the face of adversity, trauma and loss.
On the other hand, three specific constructs from the positive psychology movement have received a considerable amount of attention. It has been proposed that responding more adaptively to adversity is related to resilience, posttraumatic growth and/or simply experiencing more positive emotions. In this blog I will provide an overview of these constructs, applying them to both to the general population and individuals with disabilities.
Resilience is defined by the human capacity to bounce back from adverse events. Research studies have shown that many individuals not only persevere, but that they thrive when confronted with adversity, trauma, tragedy, or loss. Being resilient also means that you experience both negative and positive emotions in the face of adversity and these emotions are short-lived and do not impact or interfere with overall functioning. In addition, resilience appears to be the norm, rather than the exception, in individuals who are survivors of life threatening events (Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993; Bonanno, Galea, Bucciarelli, & Vlahov, 2006). Some factors that may contribute to resilience are (APA, 2015):
- Supportive relationships
- The ability to solve difficulties with realistic plans
- Keep things in perspective (consider the painful situation in a broader context)
- Good interpersonal skills
- Maintain a hopeful outlook
- The ability to cope with strong negative emotions
Posttraumatic Growth (PTG)
Posttraumatic Growth is defined as the positive psychological changes resulting from or in response to a challenging circumstance such as a traumatic event or loss (Tedeschi & Calhoun, 2004). It is not only the ability to be resilient, but also the ability to use the event to propel further growth and development (Linley & Joseph, 2005). Factors that contribute to PTG are:
- Increased appreciation for life
- Feeling increased personal strength
- Experiencing improved interpersonal relationships
- Changing life priorities
- Gaining positive spiritual changes
- Finding new meaning and purpose in life
For many years, rehabilitation psychologists described the potential for positive growth that can result from a disability (Vash, 1981; Wright, 1983), but only a few studies thus far have examined the relationship between PTG and disability. In one study, McMillen and Cook (2003) examined the “Positive by-products” of Spinal Cord Injury (SCI). Of those who participated in the study, 79% reported at least one positive change 18-36 months post SCI:
Most frequently reported were:
- Family closeness
- Additional positive by-products of SCI included-
- Gaining new attitudes and perspectives
- Improved views of self
- Improved views of persons with disabilities
- Increased gratitude
- Increased helping of others
Positive emotions are defined as positive affective states (including but not limited to contentment, gratitude, compassion, joy, love, pride, interest, and hope), which may include changes in physiological states and observable expressions. Positive emotions contribute to overall health, including psycho-neuro-immunological benefits, including reduction in pain, longevity and overall health outcomes (Gil et al. 2004; Steptoe, Wardle, & Marmot 2005) and studies have shown that frequent positive feelings or affective states predict resilience to adversity and posttraumatic growth (Fredrickson, Tugade, Waugh, & Larkin, 2003). Unlike negative emotions that tend to constrict the focus of attention, cognition and physiological reactions, positive emotions are an evolved adaptation that play a role in building lasting resources, broaden the range of thought and actions, including creative thinking, compassion and flexible goals and resources.
Strategies that may be helpful:
- Self-efficacy may increase through realistic goal-setting and attainment
- Supportive social relationships
- Participation in social, recreation, and community activities may provide opportunities for positive emotions, leisure skill acquisition, and development of support and social contacts.
- Identify and use your strengths, or regularly write down good things that occurred (Seligman et al., 2005).
- Pleasant event scheduling, is another example of an intervention that can promote positive emotions and resilience.
- Go on a vacation
- Go on a date
- Listen to music
- Meet new people
- Practice karate
- Collect those stamps you always wanted to collect
- Take the dance class you always wanted to take
- Play basketball
- Go to the beach
- Go say “I love you” to your loved ones
- Fantasize about the future
- Have lunch with a friend
- Take a shower
- Hang out with your pet
- Go to church
- Play a musical instrument
- Put on make-up, fix hair, etc.
- Read the book you have been wanting to read
- Sit in the sun
- Help someone
- Talk about your children and how wonderful they are
*Note. This blog was influenced by Dr. Dawn M. Ehde’s, one of my mentors at UW who wrote the Chapter “Application of Positive Psychology to Rehabilitation Psychology,” in the Handbook of Rehabilitation Psychology.
Edhe, D. M. (2010). Application of positive psychology to rehabilitation psychology. In
R. G. Frank, M. Rosenthal, & B. Caplan (Eds.), Handbook of rehabilitation psychology (2nd ed.; pp. 417- 424). Washington, DC: American Psychological Association.
Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and biological psychology.
American Psychological Association (2015). The road to resilience. Retrieved August 10, 2015, from http://www.apa.org/helpcenter/road-resilience.aspx
Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2006). Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack. Psychological Science, 17, 181-186.
Fredrickson, B. L. Tugade, M. M., Waugh, C. E., & Larkin, G. R. (2003). What good are positive emotions in crisis? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84, 365-376
Gil, K. M., Carson, J. W., Porter, L. S., Scipio, C., Bediako, S. M., & Orringer, E. (2004). Daily mood and stress predict pain, health care use, and work activity in African American adults with sickle-cell disease. Health Psychology, 23, 267-274.
Linley, P. A., & Joseph, S. (2005). The human capacity for growth through adversity. American Psychologist, 60, 262-264.
McMillen, J. C., & Cook, C. L. (2003). The positive by-products of spinal cord injury and their correlates. Rehabilitation Psychology, 48, 77-85
Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C.L. (1993). Prevalence of civilian trauma and PTSD in a representative national sample of women. Journal of Consulting and Clinical Psychology, 61, 984–991.
Seligman, M. E., P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive Psychology progress; Empirical validation of Interventions. American Psychologist, 60, 410-421
Sheldon, K.M. & King, L.K. (2001). Why positive psychology is necessary. American Psychologist, 56, 216-217.
Steptoe, A., Wardle, J., & Marmot, M. (2005). Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes. Proceedings of the National Academy of Sciences of the United States of America, 102, 6508-6512,
Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1-18.
Vash, C. L (1981). The psychology of disability. New York: Springer Publishing Company.