Abstract
Traumatic experiences can significantly disrupt the individuals’ flow of life, leading to adverse psychological consequences and mental conditions. Although trauma typically leaves a negative impact, it has been suggested that positive outcomes might emerge because of a negative experience (Tedeschi et al., 2018, p. 6). While some studies present positive results, there are still mixed findings on the connection between Posttraumatic Growth (PTG), mental well-being, and particular populations (Schubert et al., 2016, p. 478). Therefore, the current Specialization Plan aims to understand and explore the literature on PTG among veterans, describing major theories and conceptual frameworks used in PTG research, discussing interventions aimed at improving the veterans’ mental well-being through PTG, and outlining my study plan.
Introduction
Traumatic experiences can significantly disrupt the individuals’ flow of life, leading to adverse psychological consequences and mental conditions. Scholarly evidence suggests that encountering negative or hostile events can tremendously increase the likelihood of developing a psychological condition, namely anxiety, depression, and posttraumatic stress disorder (PTSD) (Tedeschi & Calhoun, 2004, p. 2). However, it has also been demonstrated that the process of Posttraumatic Growth (PTG) can occur after a traumatic experience, promoting rehabilitation and ensuring the restructuring of world beliefs (Tedeschi et al., 2018, p. 6). Specific populations have been proposed to demonstrate traits associated with a higher likelihood of PTG, for example, military veterans and individuals with PTSD (Schubert et al., 2016, p. 470; Mark et al., 2018, p. 904). Thus, the research on PTSD and PTG among veterans is an important topic.
Trauma, PTSD, and PTG in Veterans
While trauma can occur in the lives of various populations, individuals with military experience have been suggested to be more seriously affected by the traumatic circumstances. Literature suggests that this affliction can be mediated through PTG, with specific factors capable of promoting this process and ensuring successful rehabilitation (Pietrzak et al., 2015, p. 7). A common complication encountered by veterans is connected to symptoms of Posttraumatic Disorder (PTSD), a condition that leads to anxiety, depression, and reduced well-being (Reyes et al., 2019, p. 656). From this perspective, veterans are in tremendous need of psychological support that could mitigate the negative impact of trauma and assist them in achieving better welfare.
The complications connected to maintaining a stable mental condition can become overwhelming for veterans. Previously, research suggested that veterans are especially vulnerable to manifesting symptoms of major depressive disorder and PTSD (Pietrzak et al., 2015, p. 7). Such conditions often lead to the introduction of opioid therapy, which can cause negative effects and lead to opioid dependency. Research on specific populations prone to PTG, such as military personnel or people with PTSD, has been conducted, suggesting that individuals with a military background are more likely to show PTG (Tsai et al., 2015; Schubert et al., 2016; Mark et al., 2018). Some scholars linked this phenomenon to the adversity of military experiences, proposing that military experiences provide sufficient ground for PTG occurrence (Mark et al., 2018).
Therefore, the relationship between PTG and PTSD is essential in understanding the problems military veterans face. A person can have both diagnoses simultaneously, which aggravates the individual’s psychological state and makes the treatment more difficult. PTG is an example of the adaptive function of the human psyche that allows people to feel that they have the power to overcome serious problems (Cann et al., 2010). It often leads to positive changes in their lives, which creates the illusion of positive development and complete psychological sanity. Though, it is not always accurate because people with PTG neglect the symptoms of PTSD, which leads to the gradual aggravation of their state. The main issue is that the negative consequences of this neglect are postponed until the period of PTG ends (Cann et al., 2010). It is possible to talk about the “inverted U shape” that emphasizes the non-linear essence of psychological changes during PTG and contribute to the emotional instability of the person (Pietrzak et al., 2015). The individual who suffers from both diagnoses is usually shocked by the worsening mental state that happens without objective and visible reasons.
As PTG is regarded as a process that can result in a better rehabilitation process, knowledge about the factors connected to PTG process in veterans is essential for developing an efficient rehabilitation program. In the past, several studies have focused on PTG as a beneficial approach for therapeutical interventions aimed at veteran populations (Habib et al., 2018; Mark et al., 2018).
Overall, PTG research might be a prominent instrument for improving the psychological welfare of these individuals, introducing a pathway for ensuring positive growth. The emotional health of this population is a significant concern not only for scholars but also for medical professionals, social workers, and government bodies, which must ensure the availability of psychological aid and PTSD treatment (Dykes, 2016, p. 18). The studies on PTG reveal that therapy can be utilized to promote mental rehabilitation and stability in veterans (Mark et al., 2018; Tsai et al., 2016). Thus, social workers can promote the mental welfare of these community members, implementing PTG-facilitating therapy to effectively deal with traumatic experiences and their consequences.
PTG in Veterans
The military personnel is of special interest for scholars as the military occupation is connected to a significant level of stress and exposure to trauma. In comparison with individuals who experienced other types of traumas, such as abuse or rape, veteran experiences have a more distinct nature. Using the data from the National health and Resilience in Veteran Study, research found that 50.1 % of all veterans and 72% of veterans with PTSD reported at lease moderate PTG in relation to their traumatic event (Tsai, et al, 2015). As such, the article by Mark al., published in 2018, is a comprehensive systematic review of PTG applied to military personnel. Defining PTG as “positive psychological, social, or spiritual growth after a traumatic incident,” the authors clarify the three possible types of growth, “psychological, social, or spiritual” (Mark et al., 2018, p. 904). The main results are as follows: PTG is more likely to occur in veterans who have an elevated level of social support, spirituality, and rumination; PTG is associated with ethnic minority belonging, with veterans from ethnic minorities being more likely to show PTG; PTG is more likely to occur in active-duty personnel, “who are repeatedly more exposed to conflict and may be better equipped to manage the effects of traumatic ordeals” (Mark et al., 2018, p. 913). From this perspective, it becomes evident that there are unique factors that increase the likelihood of achieving PTG in individuals with military experiences.
Habib et al. (2018) presented a review and qualitative analysis of PTG in military and ex-military personnel, having analyzed nine qualitative studies. The authors adopt the following definition of PTG: “positive, meaningful psychological changes that an individual can experience as a result of coping with traumatic life events” (Habib et al., 2018, p. 617). As the authors aimed to assess the qualitative data on PTG in military personnel, all the included studies used qualitative methods. The authors coded and synthesized a pool of themes that were most frequently discussed by the military personnel who experienced PTG after deployment. According to the review, there are three main findings: Veterans’ process of PTG originates from deployment-related trauma; Veterans who experienced PTG reflect on six topics: life appreciation, re-evaluating purpose, personal traits improvement, connecting with others, integrating into society, and feeling valuable to society; These outcomes are reported by veterans as the most valuable experiences following the process of PTG and can be used to enhance PTG occurrence (Habib et al., 2018)
Thus, it is concluded that “many (ex-) military personnel experienced growth as a result of trauma experienced on duty, which may allow them to function better and enjoy fulfilling relationships with others” (Habib et al., 2018, p. 623). The authors suggest that PTSD can enhance the occurrence of PTG in veterans, as the emergence of PTSD is connected to significant trauma and thus higher levels of growth. Nevertheless, other literature reports mixed findings, and some meta-analyses have identified that the relationship between PTG and PTSD is challenging to define specifically (Mark et al., 2018; Schubert et al., 2016). Therefore, the overall findings on the connection between PTG and PTSD symptoms remain inconclusive.
In the recent literature, several factors have been associated with PTG in Veterans. The number of deployments has been demonstrated to have a crucial connection with PTG occurrence; as such, completing at least two deployments might be related to higher PTG levels (Cline, 2013, p. 77; Greenberg et al., 2021, p. 732). However, a study by Nordstrand et al. (2019, p. 6) does not support this suggestion, reporting that the number of deployments is not significant. Other potential factors related to PTG include the individuals’ personality and lower depressive symptomatology (Palmer et al., 2016, p. 299; Mattson et al., 2018, p. e475). Overall, the main factors facilitating PTG are adaptive coping style, moderate trauma, and deliberate rumination. These aspects could be utilized using such instruments as individual therapy, reflection, or group counseling (Schubert et al., 2016, p. 482). Other factors related to PTG are restructured beliefs, the number of deployments, personal traits, and decreased depressive symptoms.
Theories and Conceptual Frameworks
Definition of PTG
To extensively explore the subject of PTG and its applications, it is necessary to consider its original definition. Posttraumatic Growth (PTG) is defined as “a result of processes initiated by a significant challenge to a person’s assumptive world” (Tedeschi et al., 2018, p. 6). Tedeschi et al. (2018) explain that PTG is based on the idea of positive change following a traumatic event. This transformation requires the affected person to reshape their perspective on the world. This definition is based on the decades of research that shaped the core ideas of PTG. In the definition of PTG, Tedeschi et al. interpret this concept not only as changes per se but as the changes to the individual’s assumptions about the world initiated after the traumatic experience. Tedeschi et al. (2018) explain that such transformations should result from the challenge to the person’s core beliefs.
Original PTG Definition
An article by Tedeschi and Calhoun (2004) focuses on the concept of PTG and the empirical evidence that supports it. The scholars refer to their original definition of PTG and mention that it is highly significant to clearly comprehend the positive aspects of struggling with trauma to create a valid measure (Tedeschi & Calhoun, 2004, p. 6). The authors describe the theoretical and practical notions behind it, namely traumatic events, growth, and cognitive processing (Tedeschi & Calhoun, 2004). Discussing the process of PTG in detail, the authors cite empirical evidence that demonstrates the importance of achieving PTG for improving the affected individuals’ well-being.
Domains of PTG
Based on the theoretical suggestions introduced by Tedeschi and Calhoun, five primary domains of PTG have been identified. These domains are relating to others, new possibilities, personal strength, spiritual change, and appreciation of life.
Relating to Others
The domain of relating to other people occupies a crucial place in PTG. This area is understood as an increased desire to communicate with others and accept their help. Findings from contemporary studies suggest that veterans who experience PTG are more likely to relate to others, which in turn increases the possibility of successful rehabilitation (Tsai et al., 2015; Pietrzak et al., 2016). However, deployment and recurring PTSD symptoms can also affect this domain, and it has been hypothesized that extremely severe PTSD symptoms and higher numbers of deployments might prevent PTG (Greenberg et al., 2021, p. 732).
New Experiences
Recognizing new possibilities and becoming interested in acquiring new possibilities is the second area of PTG. Recognizing new opportunities and directions for life appear to also be affected by deployment and recurring PTSD symptoms (Greenberg et al., 2021, p. 732). Typically, veterans who report PTG demonstrate a propensity towards taking new paths and redefining their priorities, which is consistent with the theoretical suggestion that PTG leads to restructured beliefs. In the long term, such openness to experience can facilitate rehabilitation and promote better well-being.
Personal Strength
A longitudinal study by Tsai et al. (2016) suggests that the domain of personal strength is associated with the reduced severity and incidence of PTSD symptoms at a two-year follow-up. The authors connect this finding with the possibility that the factor of personal strength is related to the use of various coping strategies, which enhances an individual’s likelihood of successfully overcoming trauma (Tsai et al., 2016, p. 271). Similar results are reported by (Tsai et al., 2015, p. 165), who state that personal strength is associated with higher resilience to future traumas.
Spiritual Change
Spiritual change is also noted as an essential growth area, with veterans experiencing changes in their spirituality levels after PTG occurrence (Mark et al., 2018, p. 911). Such transformations usually refer to restructuring religious beliefs and adopting a different perspective on existential and philosophical questions.
Appreciation of Life
Additionally, several authors report that life satisfaction is connected to PTG experiences, with veterans who showed PTG receiving higher life satisfaction scores (Morgan et al., 2017, p. 434; Evans et al., 2018, p. 263; Greenberg et al., 2021, p. 732). Thus, the literature suggests that veterans who showed PTG are more likely to express greater appreciation of life, finding meaning in different aspects of their own lives.
Factors to PTG among Veterans
Coping styles, the severity of experienced trauma, challenges to core beliefs, rumination, number of deployments, and personal strength are the primary factors related to the occurrence of PTG among veterans.
Coping Styles
The mediating role of the chosen coping style with better PTG outcomes is supported by other research. As such, Mattson et al. (2018, p. e475) state that military personnel utilizing the adaptive coping style are achieving higher PTG than those who implemented maladaptive coping. From this perspective, such factors as increased personal strength and the use of an adaptive coping style can facilitate PTG in the veteran population.
Trauma Severity
Adverse trauma has also been shown to lead to higher manifestations of PTG among veterans. Research data from Mark et al. (2018, p. 911) suggests that military personnel who encountered more severe traumatizing circumstances were more likely to develop PTG. Currently, it is believed that PTG is related to the extent of experienced trauma, meaning that veterans are one of the few populations whose background contributes to the increased likelihood of PTG manifestation (Evans et al., 2018, p. 268). Greenberg et al. (2021, p. 732) argue that PTSD symptom severity must be moderate for securing the highest levels of growth in comparison with high and low severity, which do not yield beneficial outcomes. Thus, it appears that, in addition to personal strength and coping styles, the severity of experienced trauma also plays a critical role in PTG facilitation among military personnel.
Challenges to Core Beliefs and Rumination
A crucial area of PTG investigation in the military personnel is connected to core beliefs and rumination. As originally explained by Tedeschi and Calhoun (1996, p. 455), PTG arises because of overcoming the challenge to personal core beliefs, which must be restructured to achieve proper growth. Rumination, on the other hand, is the focus of the affected individual on their traumatic experiences. Morgan et al. (2017, p. 434) explored the effects of core beliefs, challenges, and rumination in a quantitative study. According to the results, challenges to the core beliefs are significantly connected to both voluntary and non-controlled thoughts about the traumatic events, as well as PTG. However, the scholars disclose that deliberate rumination, which is conducted by the individual willingly, is positively associated with PTG, and intrusive rumination, which includes non-voluntary negative thoughts, negatively impacts PTG (Morgan et al., 2017, p. 435). A concept similar to rumination, re-experiencing PTSD symptoms, is also mentioned by Greenberg et al. (2021, p. 732), who report identical findings. Thus, it appears that PTG can be facilitated by intentionally reflecting on the stressful experience, allowing veterans to restructure their beliefs properly.
Interventions and Policies Related to PTG Facilitation
Recovering from the military experiences is a crucial issue for numerous personnel after returning to civilian life. PTG has been extensively researched since 1996 when Tedeschi and Calhoun (1996) first introduced this concept as a possibility for approaching trauma coping. However, applying this concept in Veteran counseling has only been suggested in the recent decades, meaning that this area remains rather new. PTG is considered a prominent approach that could be utilized in social work teaching, learning, and practice to improve the well-being of traumatized populations (Dykes, 2016, p. 30; Jirek, 2017, p. 166).
With the possibility of enhancing the process of rehabilitation through the process of PTG emerging through recent research, several programs to facilitate PTG have been proposed. According to Kanako Taku, a scholar researching the manifestations of PTG in various populations, rehabilitation interventions aimed at facilitating PTG are especially effective when they incorporate relevant scientific evidence (Taku et al., 2017, p. 272). In the recent studies, Taku introduced three programs that could help address PTG in individuals from veteran and student communities, conducting research to confirm the interventions’ validity.
SecondStory
One of the proposed strategies involves performing group-based sessions that promote reflection and meaning-making in affected populations. This approach is named SecondStory, and it allows individuals with all types of traumatic experiences to battle the negative consequences of trauma through psychological growth. SecondStory integrates the recent PTG interventions, which were proven to have a positive impact on the participants’ well-being and distress symptoms. Positive psychology, future-directed thinking, meaning-making, and narrative therapy served as the basis for the intervention, which was performed on a sample of people. The inclusion criterion for the sample was experiencing similar trauma, which was identified using an original questionnaire (Roepke et al., 2018, p. 528). According to the results, although SecondStory was not significantly more efficient than other approaches for promoting PTG process among trauma survivors, it was still beneficial for facilitating PTG, meaning that it could be useful for the veteran populations (Roepke et al., 2018, p. 543).
Psychoeducational Intervention Program
Another approach suggested by Taku concerns the subject of educational interventions and their effects on promoting the occurrence of PTG in students. Taku et al. (2017, p. 271) devised a strategy to improve the students’ knowledge of PTG and research whether such initiatives could facilitate positive psychological growth. The intervention discussed stressful events, several types of reactions to them, psychological distress, PTSD, and the PTG’s potential to promote personal changes (Taku et al., 2017, p. 275). Various forms of PTG were also described, allowing the participants to understand the predictors and mechanisms of PTG. The reported findings demonstrate that learning about PTG can significantly improve the PTG prevalence rates in high school students, facilitating growth and promoting the achievement of psychological changes (Taku et al., 2017, p. 278). Many of the respondents reported PTG process three weeks after the intervention, meaning that the educational program had positive effects (Taku et al., 2017, p. 278). Although this intervention has engaged the student population, it has beneficial implications for the veteran populations currently involved in higher education programs.
Warrior PATHH: Program for Veteran Mental Health
The final method discussed refers to the psychological interventions for veteran populations. The researched strategy was named Progressive and Alternative Training for Healing Heroes (Warrior PATHH), created and studied by Moore et al. (2021). Considering the importance of using relevant research data, the PATHH program was devised with the implementation of the evidence-based approach, integrating the PTG model from the original authors and the Expert Companionship intervention strategy (Moore et al., 2021, p. 43). The resulting intervention was focused on providing the veterans with an opportunity to discuss their military and mental health-related issues with a professional psychiatrist. The intervention was delivered by experts in psychology to the participants who experienced trauma during combat exposure, addressing such topics as psychoeducation, emotional regulation, self-disclosure, narrative development, and learning about the value of life. Moore et al. (2021, p. 49) report that, although the created method is not psychotherapeutic, it helped facilitate PTG in veterans and promoted education on trauma, emotional and behavioral regulation, and well-being after deployment.
Related Policies
An organization-based policy to improve veteran welfare is implemented by the Department of Veterans Affairs (VA). The initiatives introduced by the VA address the complications frequently encountered by veterans with PTSD, anxiety, and other symptoms of severe trauma that prevent normal functioning (US Department of Veterans Affairs, n.d.). The main approaches suggested are the preventative, educational, treatment, and therapeutic interventions (US Department of Veterans Affairs, n.d.). A distinct initiative launched by VA, the Posttraumatic Stress Disorder Residential Rehabilitation Treatment Program (PTSD-RRTP), also integrates the idea of PTG facilitation to deliver group-based and trauma-focused intervention to veterans suffering from PTSD.
In addition, there are several organizations that represent the veterans’ needs and assist them with improving their psychological and physiological well-being. Such entities are Veterans of Foreign Wars (VFW), American Legion, and Iraq and Afghan Veterans of America (IAVA), which provide services to their members (Korb, 2019). These establishments’ policies offer individuals with military experiences additional help with overcoming PTSD, medical dependencies, and other disorders obtained because of military trauma.
Research Methodologies
Considering that PTG is a construct reported by individuals themselves, while PTSD and trauma can be clinically diagnosed, specific approaches to measuring PTG became of particular concern. Researchers have identified several methodologies, such as questionnaires and surveys, to explore PTG occurrence in veterans and retrieve reliable data about this process.
As PTG is not a personality trait but a phenomenon, an experience that can occur, it can be observed or measured. While observation at times is utilized, it can prove to be challenging to conduct; thus, researchers typically use interviews and surveys (Schubert et al., 2016, p. 478). Structured and semi-structured interviews are frequently utilized in empirical studies (Schubert et al., 2016, p. 478). Surveys are the most popular, as they allow for a variety of instruments and a quantitative approach (Schubert et al., 2016, p. 478). The most implemented and well-researched measures are scales that assess the process of PTG based on the participant’s reflection of the experience (Schubert et al., 2016, p. 478).
The Posttraumatic Growth Inventory (PTGI)
Tedeschi and Calhoun (1996) developed and approbated the Posttraumatic Growth Inventory (PTGI), a tool for measuring the process of PTG. The questionnaire included in Appendix A. Tedeschi and Calhoun (1996, p. 455) reported that the final questionnaire had high reliability, meaning that it could be successfully used for identifying PTG in various populations. According to other research, these domains majorly correspond to the individuals’ experiences of PTG, while PTGI is the most frequently used questionnaire in contemporary studies (Schubert et al., 2016, p. 477).
Other Measurements of PTG
Nevertheless, other instruments for assessing PTG were also suggested, resulting in the emergence of a variety of measuring tools that are based on different understandings of PTG. Other authors have introduced measures based on different conceptual ideas, such as the Stress-Related Growth Scale by Park et al. (Schubert et al., 2016, p. 478). Cohen and Murch’s Perceived Benefits Scales (PBS) consider the idea of “perceived benefits,” focusing explicitly on the changes that are regarded as positive by the individuals. Antoni et al. have also suggested the Benefit Finding Scale (BFS), which had the most reliable results (Schubert et al., 2016, p. 478).
Data Available through NHRVS
Given the large numbers of veterans and the significant scope of the problem, a national study on the health characteristics of individuals who have military backgrounds has been conducted. The National Health and Resilience in Veterans Study (NHRVS), aimed at ascertaining the well-being of veterans in the USA, has provided researchers with an abundance of data to be analyzed in connection with PTSD symptoms experienced by this population (Tsai et al., 2015). As such, NHRVS presents a nationally representative sample of 5309 US veterans. The study was launched in 2011, with the first wave of participant data collected in October-December 2011 and the second wave conducted in September 2013. In total, the survey panel included more than 80000 households.
The gathered data included a range of sociodemographic, military, health, and psychosocial characteristics. Veterans reported symptoms of PTSD, depressive and generalized anxiety disorders, problems with physical health, history of substance abuse, trauma, and suicidal ideation. In addition, such psychosocial variables as a sense of purpose, altruism, and gratitude were included.
PTGI questionnaire data is also integrated into NHRVS. The PTGI-SF taken from Cann et. al. (2010) is used in this study. PTGI-SF is a 10-item validated instrument that assesses PTGs in five domains. The results are evaluated based on the answers to 10 questions, including the following:
- the person changed the priorities they have in life;
- the person started to appreciate their own life more;
- the person managed to accomplish things better;
- the person began to understand their own needs in spirituality better;
- the person developed a bond with others;
- the person found the aims in their own life;
- the person understands better how to cope with difficulties;
- the person’s religious beliefs enhanced;
- the person understood they have more powers than they used to think;
- the person regains faith in other individuals (Cann et. al., 2010).
It is critical to remember that the short form does not provide the researchers with full-scale information. It allows scholars to concentrate on the most general spheres of life where the person might experience sudden positive changes in the process of PTG.
The NHRVS dataset can be obtained through public access and used for research on veteran health and well-being. For my dissertation research, I plan to use the NHRVS data to enhance the understanding of PTG and its occurrence in military veterans in the U.S. I am interested in examining factors uniquely associated with PTG in war veterans.
Cultural Issues in Veteran Research
Cultural issues are a vital part of the veterans’ well-being and psychological welfare, as the veterans constitute a distinct cultural community. Literature suggests that military culture has unique characteristics separating the veteran group from other individuals in trauma counseling (Weiss & Coll, 2011). It has been shown that military culture and worldviews are necessary to integrate into psychological interventions, meaning that these aspects must also be considered in research.
In addition, large numbers of veterans represent ethnic minorities, which increases the likelihood of encountering minority-related complications. There are significant ethnic distinctions between different veteran populations, with some ethnic groups experiencing unique complications (Coleman et al., 2018). Previous research suggests that separate ethnic communities are more likely to encounter such problems as lack of finances, a non-inclusive environment, and an absence of programs aimed at enhancing their well-being (Coleman et al., 2018). It has also been shown that ethnic minority veterans more frequently occupy disadvantageous social and financial positions, which further increases the risk of unsuccessful rehabilitation (Coleman et al., 2018)
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Appendix A
The PTGI questionnaire is presented below. Answers to the questions include scores from 0 to 5, where 0 implies “I did not experience this as a result of my crisis”, and 5 suggests “I experienced this change to a very great degree as a result of my crisis”.
- I changed my priorities about what is important in life.
- I have a greater appreciation for the value of my own life.
- I have developed new interests.
- I have a greater feeling of self-reliance.
- I have a better understanding of spiritual matters.
- I more clearly see that I can count on people in times of trouble.
- I established a new path for my life.
- I have a greater sense of closeness with others.
- I am more willing to express my emotions.
- I know that I can handle difficulties.
- I can do better things with my life.
- I am better able to accept the way things work out.
- I can better appreciate each day.
- New opportunities are available which wouldn’t have
- been otherwise.
- I have more compassion for others.
- I put more effort into my relationships.
- I am more likely to try to change things that need
- changing.
- I have stronger religious faith.
- I discovered that I’m stronger than I thought I was.
- I learned a great deal about how wonderful people are.
- I better accept needing others.
Appendix B
Short Form
- the person changed the priorities they have in life;
- the person started to appreciate their own life more;
- the person managed to accomplish things better;
- the person began to understand their own needs in spirituality better;
- the person developed a bond with others;
- the person found the aims in their own life;
- the person understands better how to cope with difficulties;
- the person’s religious beliefs enhanced;
- the person understood they have more powers than they used to think;
- the person regains faith in other individuals (Cann et. al., 2010).