Trauma, Social Support and Personal Growth: Implications for Living With HIV

David Fawcett Ph.D., L.C.S.W.

Trauma and its effects are no strangers to people living with HIV. A life-threatening diagnosis, virologic failure or even an HIV-positive test result can be traumatic and, over time, lead to the development of post-traumatic stress disorder (PTSD), a very serious psychiatric diagnosis.

PTSD is a delayed or prolonged reaction to trauma with three types of effects: 1) intrusion, such as recurring dreams, thoughts, perceptual experiences; 2) arousal, such as increased vigilance, fear, impatience and difficulty concentrating; and 3) avoidance, such as efforts to get rid of or numb negative thoughts and emotions.

PTSD increases the potential for other depressive and anxiety disorders, and its prevalence is known to be higher among persons living with HIV than the general population, and especially women, for whom the rate of HIV-related PTSD is estimated to be 30% -- five times that of women without HIV.

While a traumatic experience is always disturbing and potentially catastrophic, some individuals are able to respond in ways that are positive, profound and life altering. This effect, called post-traumatic growth (PTG), is characterized by positive changes in self-perception, improved relations with others, renewed appreciation of life or changes in spiritual beliefs following a traumatic event. Individuals who experience PTG may even achieve higher levels of functioning than before the trauma. It is important to note that the central concept of PTG does not not minimize the negative impact of a traumatic event but rather identifies individual attempts to deal with a crisis that have a positive effect.

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Several factors, including social support, mitigate the effects of trauma and promote PTG. A recent study of Polish emergency workers who experienced trauma offers clues to how specific types of support, along with their timing, can improve an individual's response to trauma. This is highly relevant for people living with HIV/AIDS, who experience much higher levels of PTSD and for whom the concept of PTG holds promise.

Here are specific interventions from the Polish study and other literature that promote post-traumatic growth:

1. Positive Reappraisal
   Positive reappraisal is a coping strategy that helps individuals adapt to stressful life incidents by reinterpreting their meaning. For example, following traumatic events, many individuals change their self-perception and thereby see new opportunities, feel increased personal strength and experience increased empathy and a sense of closeness with others. Skills such as having mindfulness, noticing any positive benefits (even in the midst of distressing experiences), capitalizing on those benefits and practicing gratitude are examples of positive reappraisal. Coping styles reflecting resilience, hardiness, a sense of coherence (a confidence that events in one's life remain predictable and will work out as well as can be reasonably expected), all have a significant effect on PTG. It is noteworthy that simply trying to accept one's condition, rather than focusing on resilience, has been found to have the smallest impact on promoting PTG.
2. Receiving Social Support
   The Polish study notes that, while social support, regardless of its source, is essential for dealing with trauma, the sequence of various types of support is critical. In the period immediately following a diagnosis (or adverse event), emotional support from family and friends, such as comfort and reassurance, can help someone find positive meaning in the experience. However, this effect diminishes over time, with instrumental (or tangible) support, such as help with childcare/housekeeping, transportation or even money, becoming more important not only for preventing adverse consequences but also for promoting PTG.
3. Expressing Thoughts and Feelings
   The Polish study found that disclosing one's own reactions, including those that would be considered negative, is beneficial not only for improving one's quality of life but also for developing better relations with others. For example, a study examining factors related to PTG among people living with HIV found that disclosing HIV status to sexual partners and others, when possible, reduced the harmful psychological effects of HIV-related stigma. Finally, the act of expressing thoughts and feelings was found to increase awareness of new life opportunities.
4. Spiritual Well-Being
   Retaining spiritual well-being can be especially challenging following traumatic events, but studies show that it has one of the larger effect sizes on PTG. Spiritual well-being has been shown to mitigate psychiatric distress, increase health-related quality of life and even improve CD4 cell counts. In one study, a significant inverse relationship between spiritual/religious practices (prayer/meditation and reading spiritual/religious material) and depressive symptoms among African-American women living with HIV was documented.

Living with HIV creates abundant opportunities for traumatic reactions and other co-occurring mental health disorders, but we are discovering that the attitudes we bring to the situation, along with various skills, can increase the chances not only of improved health outcomes but also increased personal growth.

David Fawcett, Ph.D., L.C.S.W., is a substance abuse expert, certified sex therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Florida. He is the author of Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery.