Growth Through Loss After Brain Injury

I is well recognised that people can derive meaning from and experience positive psychological changes even in the most adverse circumstances surrounding illness and trauma. Although many different theories of ‘posttraumatic growth’ (PTG) exist in the literature (see Zoellner & Maercker, 2006), there is consensus that when people experience an event as traumatic or highly stressful, their global assumptions about themselves and the world can be shattered. Those who perceive the impact of the event to be more threatening (or less congruent with their prior beliefs and values) are more likely to experience psychological distress. Such distress can propel a series of introspective processes and coping behaviours in efforts to make sense of the loss. In time, these processes can restore one’s sense of meaning in life and lead to fundamental changes in values and directions in life, self-identity, relationships and a deepened spirituality (Park, 2010; Tedeschi & Calhoun, 2004; Zoellner & Maercker, 2006). Psychological growth is not inevitable after trauma, however, and distress can often be endured without the person understanding its meaning or drawing psychological benefits. Tedeschi and Calhoun’s (2004) theory of PTG argues that effortful cognitive processes (e.g., reanalysis and reinterpretation of the event and its meaning) play a key role in transforming people’s beliefs about themselves and the world. Hence, the extent to which this can occur and factors influencing PTG for people with significant neurological compromise after brain injury is intriguing from a theoretical viewpoint. Further, given that greater PTG is associated with better mental health in the long term (Helgeson, Reynolds, & Tomich, 2006) a more advanced understanding of meaning-making processes after acquired brain injury is essential to inform psychological interventions. Brain injury is without doubt one of the most life-altering events a person can experience. The immediate circumstances of the injury are often life-threatening, while the ongoing physical, cognitive and behavioural consequences can threaten independence, relationships, livelihood and sense of self. It is perhaps because of the well-recognised adverse consequences, including depression and psychosocial dysfunction, that positive psychological changes after brain injury have received little attention in the literature. Although some authors have investigated successful adaptation and positive outcomes after brain injury (e.g., Gillen, 2005; Nochi, 2000; Strang & Strang, 2001), such studies are rare for brain injury compared to other chronic and life-altering health conditions. There is a small body of relatively recent studies that support the view that people can experience positive changes in their outlook and behaviour, an enhanced sense of self and stronger relationships in spite of, or because of their brain injury (Collicutt McGrath & Linley, 2006; Collicutt McGrath, 2008; Gangstad, Norman, & Barton, 2009; Nochi, 2000; Powell et al., 2007; Strang & Strang, 2001). The focus on PTG as part of a positive psychology perspective represents a promising area of research and clinical practice in brain injury rehabilitation. This special issue is devoted to the concept of PTG after brain injury, with articles spanning the theoretical foundations of PTG and positive psychology, empirical investigations of the nature of and circumstances promoting PTG, and psychological, social and occupational interventions for enhancing growth and engagement in meaningful activities and life roles.