Newsletter: May 2015

The New Science of Post-Traumatic Growth

Even the possibility of post traumatic growth is of interest to someone who wrote a book on bouncing back from adversity and disaster. In Upside: The New Science of Post-Traumatic Growth, (available August 2015) Jim Rendon presents new data that demonstrates post traumatic growth is not only possible but is a far more common outcome of trauma recovery than psychologists or physicians have previously thought.

“Why Terrible Experiences Can Be Good for You: The Science Behind Trauma and Positive Growth” is not just glib or Pollyanna and in no way minimizes the devastation people who are traumatized experience.

This kind of growth, the kind that can dramatically alter a life for the better, does not occur as a result of just any upsetting event. What is required is a seismic event – a trauma that shakes you to your core. Growth is a rethinking, a reassessment of yourself and the world. You don’t need to go through that if everything still makes sense to you. If a person is like a building built to a high standard to withstand an earthquake, if the quake comes and the building is still standing, you are okay. But if the building suffers damage, it has to be rebuilt and the rebuilding is the growth. The challenge is to see the opportunity presented by this seismic event. In the aftermath of the earthquake, why not build something better? Don’t just live beneath the rubble, don’t just build the same old building that you had before….
– Richard Tedeschi, professor of psychology, University of North Carolina, Charlotte

Nothing is easy; everything is possible.
– Hawthorne Smith, professor, NYU School of Medicine

Events that are outwardly bad, even horrific, can spur survivors toward positive life changes. The key finding of the new research is that positive life changes can occur not in spite of but because of trauma, more than anyone could have predicted.

Upside is instigating a paradigm shift. Trauma research has long been ignored, though people have always experienced it. (What is now recognized as post-traumatic stress disorder was called “soldier’s heart” in the American Civil War, “shell shock” in World War I, “battle fatigue” in World War II. And there is some synchronicity in me posting this newsletter on Memorial Day.) After the war in Vietnam, physicians began to take seriously the debilitating and seemingly intractable symptoms of nervous systems stuck on high alert, people experiencing recurring flashbacks and nightmares, unrelenting anxiety or depression. In 1980 the “bible” of psychiatric disorders included Post-Traumatic Stress Disorder, recognizing the legitimate suffering of people struggling to cope with trauma.

Mental health professionals at the time focused on the event of “capital T” trauma – a plane crash, rape, hurricanes/tornados, injury, terminal illness, sexual abuse, death of one’s child or spouse, financial/career loss, combat, being a prisoner of war or war refugee, imprisonment – events considered catastrophic enough they would overwhelm the defenses of any human being, distinguished from “small t” trauma – events that overwhelm some people but not others – flying on a plane, going to the dentist, speaking in public.

Upside shifts the focus again, reporting on the research that shows that while 75% of all Americans will experience at least one capital T traumatic event sometime in their lifetime, and while 8% will develop PTSD, sometimes struggling with that for years, more than 50% of all people who experience trauma recover from trauma in what is now being termed Post-Traumatic Growth. Trauma is now being defined as an event which “upends” your previous view of yourself and your world, your sense of identity and how the world works. Not just overwhelming but shattering. “Normal is never going to be what normal used to be.” It’s the process of re-building and re-discovering who you are in a world where “bad things happen to good people” that fosters new meaning, new purpose, new direction for people. Not just bouncing back but moving into a new sense of fulfillment and thriving. That’s the growth.

One further push of the envelope: post-traumatic growth occurs not just in spite of the trauma but most of the time because of the trauma.

How you respond to the issue….is the issue. – Frankie Perez, Momentous Institute, Dallas, TX

Choice is key. I teach everywhere I go: we can choose experiences that will create new circuitry in our brains, creating new patterns of response to life events, current, past, and moving forward.

Jim Rendon does us all a great service outlining these choices, based on three decades of solid research with trauma survivors who meet the measures of post-traumatic growth. This path of post-traumatic growth is a series of steps effective for all of us coping with disappointment, difficulties, even disasters.

* Acceptance of reality. This happened. Never should have. Not fair. Consequences devastating and coping/recovery is enormous work that goes on for years. Accepting, this is the new reality.

* Support from family who believe in recovery and healing, who encourage, who never give up; help the person hang on through the depression and disorientation so frequently experienced in a catastrophe and the impact that continues to be felt day after day after day after day after day.

* Finding a community of other people with same trauma; people who have been there and who know. Camaraderie and common humanity help us want to stay on the planet; we can stop feeling sorry for self and engage with, even help, others in the same struggle.

* Positive re-framing, finding the positive meaning in a negative event. A regrettable moment becomes a teachable moment. While reading Upside to write an endorsement, I met a woman on a plane reading a book called Resilience: Hard-Won Wisdom for Living a Better Life by former Navy SEAL Eric Greitens who offers the same wisdom: in recovering from trauma we can build purpose, confront pain, practice compassion, develop a vocation, find a mentor and create happiness. According to the data Jim Rendon presents, it is human nature to look for the positive in catastrophe.

* Helping others; connecting through service and passing along what we’ve learned. What have you learned about life that you would want to pass on. (Early research into PTG asked those questions; talked to people rather than assessing them, and then put the “scientific shine” onto people’s stories.

* Appreciating that the new life came because of the catastrophe, not just course correction but an entirely new direction.

While every life journey is different, these steps are part of the core of recovering resilience and well-being. Because there is no returning to baseline for people whose worlds have been upended by trauma, a traumatic event is not simply a hardship to be overcome. The trauma becomes a dividing line in people’s lives. It can catalyze deep transformation. People do more than survive; they become wise.

May these reflections and tools be useful to you and yours.

REFLECTIONS ON POST-TRAUMATIC GROWTH

Upside’s chapter headings give us a clear indication of what steps the path of post-traumatic growth might include:

* Telling a New Story: Why Your Narrative Makes or Breaks Growth
* Relying on Others: Community and Support Are Vital for Change
* Expressing Yourself: Growth Demands Honest Communication
* Focusing on the Positive: The Transformative Power of Optimism
* Finding Meaning in Faith: the Religious Path to Growth
* Opening Up to New Experiences: Creativity Spurs Change
* Racing Boats and Climbing Mountains: Getting Active Opens the Door to Growth
* Bonding with Those Who Get It: How the Sad Dads Saved Each Other
* Managing Distress and Learning to Grow: the Path to Change through Therapy
* Fulfillment vs. Happiness: Why Growth Will Last a Lifetime

I’ll highlight just some of the research data and insights here. I’ve included more information in the Poetry and Quotes to inspire below. I’ve included a wonderful story in Stories to Learn From below about how racing dragon boats fosters post-traumatic growth among breast cancer survivors. And the Exercises to Practice section offers an exercise to create a coherent narrative after a tragic event.

From Chapter 4 – Telling a New Story: Why Your Narrative Makes or Breaks Growth

Most of us get through our days believing “bad things don’t happen to good people.” A traumatizing event seriously challenges that belief system, even “upends” or shatters it.

The ability to abandon the old assumptive self or narrative and to develop a new one is at the heart of the process that can result in post-traumatic growth. People are always telling themselves stories; it is how we make sense of the significance of what has happened to us. In the wake of trauma, people are often telling themselves stories of mental defeat and hopelessness. And they need to be in a position to begin reframing their story, as one that looks to the future and begins to view things in a beneficial way.
– Stephen Joseph, University of Nottingham

To do that, people need to be able to integrate the new traumatic experience into their lives. According the theories advanced by developmental psychologist Jean Piaget, we usually assimilate new information by fitting the new experience into our existing way of understanding the world, which keeps that worldview intact. Joseph uses the example of a child playing with blocks who is handed a magnet. When she assimilates the magnet, she stacks it on top of her tower as if it were another block – the magnet is being absorbed into her worldview of objects as blocks.

But if the child discovers that the magnet attracts metal and begins playing with the object as a magnet, then she is accommodating the new information – building a new construct that takes into account the different properties of this new object. Similarly, survivors must reconstruct their worldview into one that accommodates the new properties the trauma embodies. If they don’t, they will be constantly pushing back against the memories and associations of the event with anger and frustration. They will continue to try (and fail) to build the tower higher using the magnet as a block. But if they do manage to accommodate the traumatic experience by understanding that it requires a new worldview, the trauma can become part of the foundation for a new way of understanding themselves, perhaps even the starting point for a whole new and better life. Magnets, after all, can do many things that blocks cannot.

Telling other people one’s story, even going public and speaking to large groups about what happened and how the person has chosen to cope since, helps the person cohere their own story into a new meaning: this is how I got to be where I am today.

Being open and forthcoming about what happened to me and the problems I had has helped me to deal with my own issues. Before it was about internalizing and repressing and denying everything. Now I am an open book. I love it. It has been amazingly rewarding.
– George Nickel, Iraq veteran, recovering from traumatic brain injury from IED explosion

From Chapter 6: Expressing Yourself: Growth Demands Honest Communication

Traumatic experiences tend to remain in the victim’s awareness until they are either made sense of cognitively, or they simply fade with time. Making sense of trauma – understanding it and coming to terms with what it means – is a relatively efficient way of comprehending and accepting adverse experiences. Waiting for a trauma to fade away can take an awfully long time and lead to lots of problems. By talking or writing about difficult experiences, survivors are forced to translate them into language which is particularly important with traumatic memories. The way traumatic events are processed in the brain often circumvents language centers. Life-threatening events activate the amygdale, the brain’s fear center. Those memories are red hot with emotion but devoid of language and context. Writing helps survivors to label the experience, attaching language to it that allows survivors to understand and process the event instead of leaving it as some untethered red alert adrift in our neural wiring. Once that’s done, people can assign it meaning, some level of coherence and give the event a structure and place in their lives.

You start asking yourself how this affected me, how it changed my relationship with this person, the way you think about life and death, to see how the major upheaval touched every part of your life.
– James Pennebaker, chair of psychology department, University of Texas-Austin

From Chapter 7: Looking for the Positive: The Transformative Power of Optimism

Focusing on the positive – not necessarily the idea that good things will happen in the future but simply looking for positive things and events in the present is remarkably helpful in recovery from cancer and other traumatic events.

People with a positive attitude have lots of advantages over others in these situations. They have broad and deep support networks. They are more integrated into their communities. They live longer and have more fulfilling lives. It’s an advantage for everything.
– Sharon Manne, Rutgers Cancer Institute

This is not to say that people should pretend that a terrible event is actually great. Instead, they need to assess the change that it has brought to their lives and begin to understand how to integrate it with who they are and who they want to be going forward. The more that one can focus on the positives, to find even the tiniest thing that is beneficial, the better off they will be.

From the cancer I learned to stay focused in the present. People want something to make them happy instead of just being happy. This whole experience has taught me that if you wait for something external to make you happy, you are missing the point. It’s a choice. You just have to be happy and to be really happy you have to live today, not yesterday and not tomorrow. You have to live in the moment because that is what matters and that is what you can control.
– Matt Cotcher, brain cancer survivor

From Chapter 12: Managing Distress and Learning to Grow: the Path to Change through Therapy

After a traumatic experience it’s common to think about the event, even to the point of obsession. Survivors often suffer from intrusive thoughts – images of the event that come back to them with little warning, often creating tremendous anxiety. People may try to avoid thinking about the event entirely to forestall these images and memories, and research suggests that may actually be a healthy and necessary part of recovery, but only for a time.

If the process stops there, this kind of avoidance can ultimately impede healing and growth. Images of the event will continue to plague the survivor, regardless of his or her efforts to avoid the triggers that bring them flooding in. And choosing to wallow in negative emotions for too long can become debilitating and an impediment to change. What is required instead is something researchers and therapist call deliberate rumination.

Deliberate rumination is a different kind of thought process, one driven by the individual, not the trauma. It is not wallowing or obsession. When someone is deliberately ruminating on a problem, he is actively involved in thinking about how the event has impacted him, what it means for him, and how he can live his life going forward, given the challenges that the event has posed. When deliberately ruminating, the trauma survivor is actively tackling the challenges that the trauma has introduced to the assumptive world. Deliberate rumination is the way that people begin to rebuild themselves. Deliberate rumination can allow a trauma survivor to construct a new view of themselves and the world.

Instead of looking back with guilt and self-loathing and criticism, they are often able to understand their behaviors in the context of the trauma, allowing them to move from self-criticism to acceptance.
– Pamela Fischer, psychologist, Oklahoma City V.A. Medical Center

Survivors create a timeline of their lives, one that points out the good and bad things that have happened to them, including the traumatic events. This helps the client begin to work on a narrative approach to their post-trauma recovery – telling the story of who they are and how the trauma changed them. Patients think about how they have changed through their lives. This can help adults, who often have a static view of themselves, understand that they have indeed changed a lot – perhaps they had a rebellious teenage phase or a seek phase in their 20s, maybe they changed careers or divorced and remarried. This helps prime them for the idea that they may be in store for another life change. And it can help them see that some change in identity is normal. This process can also help to start a discussion about how they viewed the world before the trauma. Then, in time the discussion could naturally move towards how the trauma has upended their understanding of themselves and the world around them. Ultimately the goal is to let the client decide how their identity, their sense of the world, can be reinvented.

We try to focus on the aftermath of the event rather than the event itself. The event is a catalyst for a cascade of reactions, and we are interested in what people make of all of that. And how, as a result of that cascade of reactions, there is a real rebuilding opportunity.
– Richard Tedeschi, professor of psychology, University of North Carolina at Charlotte

Deliberate rumination is at the heart of growth. It’s an important process that allows trauma survivors to find new narratives for their lives, new ways of understanding their strengths and possibilities and more meaningful ways to live.

From Chapter 13: Fulfillment v. Happiness: Why Growth Will Last a Lifetime

Trauma is not the debilitating experience that it seems to be. Those who survive traumatic experience have, by definition, survived. And given that they came so close to death, that they lost so many things they once took for granted, they understand on a much deeper level, in a much more informed way, what it means to be alive. Like few others they understand the gift and opportunity that exists in simply being alive.

Many are driving to do worthwhile and meaningful things with their lives. And those pursuits bring each of them the kind of eudaimonic happiness that they rarely experienced before. It is part of why they do what they do and it is certainly part of why they will continue to live their lives according to the new course that was laid out for them the day they crossed paths with tragedy. They understand that trauma, for all the misery it brings with it, also presents a remarkable opportunity.

H’Sien Hayward, survivor of a devastating car accident, is nearing the 20th anniversary of her accident. She has been in her wheelchair longer than she was an able-bodied person. She has often thought about how the accident divided her life into two halves, and how her life after the accidents was so different. The accident, the growth it sparked in her, has been a gift. “I’ve always been a cheerful person, but my happiness seems deeper now, more profound. My accident taught e that all of life can have beauty in it, both things that bring pleasure and those that bring pain. And it crystallized my life’s work – I get to spend my days researching happiness, and am training to become a clinician. I love what I do, who I am, can’t imagine a better life. The way I look at life is that we are all working for personal growth, either we are conscious of it or not, but we are bettering ourselves. Everyone is trying to get up the same stairs but when you have something so difficult to challenge you, it’s like you have been given an elevator to rise up several levels.”

POETRY AND QUOTES TO INSPIRE

Trauma causes change. There are a lot of opinions out there about how that change manifests, but you just don’t stay the same. That is a really radical idea. You do recover in some ways, but that recovery doesn’t actually involve returning to the baseline. It involves recalibration towards something new. PTSD is a way of describing that in a very negative light, and post-traumatic growth is a way of describing that in a very positive light.
– Rachel Yehuda, director of the Traumatic Stress Studies Division, Mount Sinai School of Medicine.

* * * * *

It is not the actual trauma that is causing the change. It is how people interpret what happens, how what they believe about themselves and life and the world gets shaken up, not the trauma itself that forces people to experience growth.
– Suzanne Danhauer, associate professor of social sciences and health policy, Wake Forest School of Medicine

* * * * *

The person is not abnormal or crazy; they are going through an abnormal or crazy situation. Finding meaning in their experience in their experience is a natural step that many patients are able to take. The point is to help patients to regain some kind of control, to realize that their circumstances were extraordinary, that they are reacting in a normal way, that they are not ill and that they do have the skills and courage to overcome this adversity.
-Hawthorne Smith, NYU School of Medicine

* * * * *

[In 1968, George Cleland lost both legs and an arm in a grenade explosion in Vietnam. In 1976, President Jimmy Carter appointed him head of the Veteran’s Administration.]

It was so valuable to me that I got a chance to help those who were also suffering. I had a powerful sense of validation that somehow all the crap has some kind of meaning.
– George Cleland, former U.S. Senator, Georgia

* * * * *

For those at the far end of the spectrum, survivors of genocide, for example, their world may be so shattered, the trauma so all encompassing, that they may have little left behind with which to rebuild. They may become functional, but significant growth may be unlikely. And, those who experience only a mild traumatic experience may not have their world and sense of self disturbed enough to force them through the kind of process required for change to occur.

It is the mid-range of experience where most studies show the greatest potential for growth. That mid-range is quite broad, encompassing those who suffer from full-blown PTSD to those who manifest only some post-traumatic symptoms. It even can include those who didn’t directly suffer the trauma but are close to those who did.

Even among those who suffer the most, PTSD is not impediment to growth. In fact, it often sets the stage for the kind of rumination that is necessary to grow. When a person is suffering from PTSD, that is point at which he is beginning to try to make sense of the trauma, integrating his experience back into everyday life. and trying to rebuild his sense of self. Once the person is able to have some level of control over the fear that is part of the experience of PTSD, he can begin the process of making meaning of his experiences.
– Jim Rendon

* * * * *

Controlling fear, anxiety and depression is no simple feat. In fact, the response to such events is often so overwhelming that most people simply try to avoid it altogether. Some people block memories of the trauma entirely, almost erasing them from their consciousness. Unfortunately, that doesn’t work. The memories remain and can be triggered with little warning by seemingly unrelated sights, sounds, or smells. Other people protect themselves from trauma by separating all the emotions from the events. Unfortunately, this often leads to behavior problems – the person can act out on those unexamined feelings by hurting themselves or others. And some people simply try to duck the issue entirely using what is called avoidance – making great efforts to avoid any events or situations that might bring traumatic memories flooding back.

All of these means of attempting to hide from the trauma can help people to handle the initial, overwhelming impact of the event, particularly in its immediate aftermath when survivors are too fragile to examine and process what has occurred. So people adopt these coping techniques, often subconsciously But none of these approaches are effective long-term strategies for coping with trauma. If people hold onto these strategies for too long, their healing process will be thwarted, which can lead to behavioral problems like substance abuse or other self-destructive activity.
– Jim Rendon

* * * * *

Many trauma survivors also suffer from survivor’s guilt. By reviewing the physiology of trauma, they can better understand their flight or fight response, helping them to realize that these responses are hard-wired and out of their control. Once the client understands this, he or she can begin to comprehend more clearly what may have been their fault and what was out of their control. When appropriate survivors can let go of the guilt – they cannot be responsible for something they do not control. By using these techniques clients can begin taking control of their post-trauma symptoms themselves, something that gives them a renewed sense of control and mastery – a first step towards believing in their own inner strength. Just giving people some tools to manage their anxiety, depression, and other post-trauma symptoms helps them to begin to see some positive changes in their lives.
– Jim Rendon

* * * * *

Pain is one of those experiences that becomes the catalyst that forces introspection. In a way, you can only be so miserable for so long before you try to find a way out. The pain can provide the pivot point. People reach a point where they are just trying to find a way to reach beyond the pain and embrace life again.
– Robert Neimeyer, psychology professor, University of Memphis

* * * * *

Anything can be overcome by determination, and trauma can be turned on its head to provide a springboard for something better.
– Jim Rendon

* * * * *

[Psychologist have long been aware of the value that social support provides for trauma survivors. Those with strong social networks report less PTSD and depression. It is support from those who understand what the survivor is going through, who the individual feels he can be open with that provides the most benefit. The extent to which a person listens to someone, accepts them, that the immediate social response is supportive and accepting of the idea of growth and doesn’t slap it down, that is important. Those who have the strongest social support report the most growth, sometimes 50% more than others.]

The Sad Dads (fathers who had lost a child to cancer) provided these grieving fathers with the kind of social support they couldn’t get anywhere else. Outside of this group, they felt like no one could relate to their experience, but within it they were surrounded by those who understood. There is nothing like crying and hugging and doing this with your brothers, your Sad Dad fraternity. To see these guys develop this intuitive, supportive, safe place, it is really extraordinary. They talk about just about everything and it is private, it is safe and confidential. They don’t judge, they just support each other. I think that has helped to change who they are, to have that emotional safety.
– Sydney Birrell, member of Sad Dads

* * * * *

[While avoiding memories and emotions associated with a traumatic event can be a helpful short-term means of coping with trauma, in the long-term, confronting pain, suffering and loss rather than avoiding it is a crucial step in healing from trauma. When religious people suffer a traumatic event, they are able to place their suffering in a larger context. They can find some meaning in the experience and will be driven to search for significance in the event.

Most people have something in their lives that they consider sacred regardless of their faith. If they can identify those things in their life that have the deepest meaning and then work to better incorporate them into their lives, they are more likely to heal from trauma and change for the better. With these sacred pursuits as a guide, people can help people to reorient their lives, find meaningful goals, and to ultimately grow.]

It can be anything, a loving relationship, work, the environment, making the world a better place. With people who are depressed, who have experienced PTSD, who have lost everything, I ask them to dig down deep, to find what makes them special, what lights them up, where the spark is. And I ask them to fan that flame. And amazing things happen.
– Kenneth Pargament, Bowling Green University

* * * * *

People who are more grateful will develop less depression or anxiety when they go through an illness. If you are grateful, you realize how many positive things there are in your life and through this acknowledgement and awareness you have better post-traumatic growth.
– Chiara Ruini, associate professor, University of Bologna, Italy

* * * * *

One of the personality traits correlated with post-traumatic growth is openness to new experience. People who have this trait often have an interest in, and appreciation for art. They are more emotional, adventurous, imaginative, and curious. They are willing to try new things. And openness to new experience is the personality train most predictive of creativity.

Today art therapy is well established and encompasses a broad range of approaches. Expressive writing is considered one form of art therapy. But so is the use of visual arts such as painting and sculpture, as well as performance arts such as music and dance – any means of creative expression can have therapeutic value for those suffering from post-traumatic stress and other problems.

Those who use these therapies with their patients say that it works because it helps focus people on new activities that absorb them in the process of creating something. That absorption or flow an intense concentration that merges both action and awareness, has benefits. It can produce a sense of competence, accomplishment and positive motion. People enjoy it and engage in an enjoyable activity has it own benefits, particularly as one struggles with deep and sometimes overwhelming problems. And tapping into creative ways of thinking in art can help inspire people to find more creative ways to address their problems.
– Jim Rendon

* * * * *

Only what I created after my illness constitutes by real self.
– Henri Matisse, painter

* * * * *

Group therapy often works best. When people come from cultures where there is a tradition of gathering with friends and family and talking things through, a group mimics that comfortable setting. And these survivors have deep common experiences that they are not likely to find in many others. To hear from someone who has gone through something similar and has managed to shed light on what has been helpful to him or her, that message is so powerful. Members of the group internalize the fact that they are instrumental in the healing and growth of others. Their experience is not just negative, their ability to overcome is valued and valuable. Perhaps, mostly importantly, there is laughter. In these groups people find humor in things that others would find horrifying. Laughter helps them immeasurably.
– Hawthorne Smith, professor, NYU School of Medicine

* * * * *

Meaning is crucial to what we do. We are big promoters of people looking for meaning in life. And the meaning that people find in the wilderness, the lessons they learn, quickly translate back into their lives at home. You have to be present in the situation on a climb. You need to make the right decisions to promote well-being. It should be a short bridge to take that lesson back to home. People turn around and want to be mentors to give back. People often say that the did not know until they had this experience that they had this power.
– Tim O’Neill, founder of Paradox Sports

* * * * *

Growth is not just a flash in the pan. Instead it is proving to be a dramatic shift that stays with people and changes their lives for the duration. The further down the track you were, the more post-traumatic growth you reported, the more positive attributions they had about their injury, the more their lives became positive. Not only was the growth persisting, it was increasing.
– Trevor Power, consultant psychologist, Berkshire National Health Service Foundation, Reading, England

STORIES TO LEARN FROM

[Upside shares many real stories of real people who have faced and survived some of the worst traumas that can happen to a human being. I include this story from Chapter 10 because it is emblematic of the insight of the German philosopher Friedrich Nietzsche, “Whatever doesn’t kill you outright makes you stronger.” Other stories in the book are just as compelling and relevant to learning the path of post-traumatic growth.]

Early on a Saturday morning, 20 women sat in two long and perilously narrow boats tied to a dock in Flushing Bay in Queens, NY. Wearing baseball hats, sunglasses and life jackets and clutching paddles, they listened to one of their coaches, Akila Simon, as she got them fired up for the morning workout.

“Close the door on fear as you paddle today. If you are afraid to get down, close to the water today, let that fear go and go for it. You are super strong,” she told the women. “Throw fear out the window.”

And with that the women pushed the boats back from the dock, turned them and paddled out into the bay where the tip of La Guardia Airport’s runway meets the water.

Donna Wilson, a co-founder of this group, The Empire Dragon Boat Team, stood at the back of one of the boats holding a long paddle that is used like a rudder to steer. As the women paddled, launching the boat forward with each stroke, practicing starts and sprints, Wilson shouted at them encouragingly, a little intimidatingly. “Dig it, dig it down,” she yelled, urging the women to get their paddles deep into the water so they would get more power on each stroke.

For nearly two hours that morning, the women zipped back and forth across the bay in their long, narrow dragon boats that were traditionally raced in China. The boats raced each other in short, all out sprints and longer, paced distances as the women yelled good-natured put-downs across the water at each other to inspire the competition.

These women are serious competitors, but they are not just any group of rowers. This dragon boat team is part of an international league of boats raced entirely by breast cancer survivors. This team was co-founded by Wilson, a nurse, and a personal trainer at Memorial Sloan Kettering Cancer Center in New York City. When she came to the hospital in 1992, she was working with lung cancer patients, and she discovered that if patients exercised for just three weeks prior to surgery, they had much better outcomes. She knew from both research and her first-hand observations, that exercise was important for recovery, too, but others seemed unaware of the value of staying active. Doctors and nurses routinely told cancer patients to just rest after chemotherapy without mentioning the value of fitness. After such a long stretch of inactivity, it took most cancer survivors a year of hard work to get into reasonable shape following remission.

When Wilson began working with breast cancer patients, the situation was even worse. After surgery, women were told that they couldn’t lift more than five pounds and couldn’t do any repetitive motion exercises. Doctors feared that it would increase the possibility of lymphedema, a common complication for breast cancer survivors that causes painful swelling of the arms. But there was little research to back up this assumption. Finally, in 2009, the first long term study of the effects of upper body exercise in breast cancer survivors was published. It showed that there was no link between the workouts and lymphedema.

While researching potential exercise programs for breast cancer survivors, Wilson found a study that revealed significant benefits from dragon boat racing. She’d never even heard of dragon boats before, but she quickly discovered that the sport had been growing for years – the first dragon boat team comprised of breast cancer survivors was founded in 1996 and today there are more than 110 teams around the world. It seemed like a great way to get women exercising and keep them active and engaged with their health and fitness. When Wilson started her team in 2009, doctors at Memorial Sloan Kettering were skeptical. “I had some people saying you can’t do this,” says Wilson. But the team’s success helped to overcome that skepticism. “Now I feel so proud to watch the passion in these women that never really exercised before, to see them get fit, watch their diet. They are totally different women,” says Wilson. “It’s very exciting to see the change in them.”

In one of the dragon boats out on Flushing Bay that morning, Heather Maloney plunged her paddle into the water and pulled back with her whole body, tensing the muscles in her shoulders and neck. She kept her head looking forward and her arms straight, focused on keeping time with the woman paddling in front of her as Wilson shouted at the rowers. Maloney, who today is trim and fit with short blond hair peeking out from beneath her cap, was diagnosed with breast cancer in 2009 when she was 44. Cancer was something she was quite familiar with – at the time she was the executive director of a pediatric cancer organization and spent a lot of her time in cancer wards. But nothing prepared her for the way cancer would upend her life. The day after her diagnosis, she began making changes.

“I woke up the next day knowing a few things and one was that I wasn’t going to die in this apartment on East 78th Street, ” she says of her home at the time. She quickly moved to a tiny waterfront community on the New Jersey side of the Hudson River. Now she wakes up to birds in the morning instead of delivery trucks. She also decided that she would forgive everyone in advance for all of the insensitive and inappropriate things they were going to say to her. (Thanks to her job, she knew that even the most well-meaning friends and relatives said rude and offensive things out of sheer fear and awkwardness.) And she would accept anything and everything that people gave her – time, food, money, clothes – without guilt. “I never questioned myself,” says Maloney. “There is such freedom when death is possible; you become very present in your life in a way that is different. All the B.S. flies out the window.”

Maloney’s treatments were brutal. Her surgeon removed 13 lymph nodes – three tested positive for cancer. She endured six months of chemotherapy and participated in a clinical trial as well. “It was like being in a vat of chemicals. It was a horrible drug,” she says. She had 30 radiation treatments. An expander, an inflatable implant, was placed under the muscled in her chest to stretch them out to make room for a permanent implant. It stayed there for eight months and was incredibly painful. Then came hormone therapy. “The fatigue was bone crushing,” she says. “I had joint pain. It was like being old. I wondered if I would ever feel well again.”

Maloney had never played sports growing up and never considered herself particularly athletic. But when she heard about the dragon boat team at the hospital, it sounded appealing. Maloney isn’t married and has no children. Hobbies and groups are important to her. The idea of being part of a team sounded right. “The moment I slice a paddle in the water, I knew. I knew immediately I was in.”

The team is a serious commitment. The women go through dry-land training in the off-season. They are in the watr twice a week, in Flushing Bay, which is better known for dead rats, floating garbage and sewage overflow than as a venue for any serious athletic endeavor. Team members are rarely permitted to miss practice, so summer vacations are curtailed. The commitment and competitive focus appealed to Maloney.

Not long after she joined she found another less obvious benefit. The team is its own remarkable community. Every year the group takes a trip to Florida for early season training. The women stay together, train together all day, every day. Their friendships deepen and they come together as a team. In the off-season they do volunteer work together. They have all become good friends, bonding over their sport and also their common cancer experience. They make jokes about their fear – every ache and pain is an indication of a new cancer about to spring on them. “We have this ability to talk about our experiences with people who understand. There is a humor to it that we couldn’t have with our other friends. They would be horrified,” Maloney says.

And it is just that kind of social connection that has been so helpful to these women. As one researcher found, it’s likely it’s the secret ingredient that helps these cancer survivors to grow.

Meghan McDonough, an associate professor in the department of health and kinesiology at Purdue University had been a competitive paddler since high school and had raced and coached dragon boats since 2001. She was curious about how the sport was benefitting breast cancer survivors. For a study published in 2007, McDonough and her colleagues interviewed 20 breast cancer survivors on a dragon boat team in Vancouver, British Columbia. McDonough found widespread post-traumatic growth among the 20 women they interviewed. Seventy-five percent of them reported having closer personal relationships and indicated they were pursuing new possibilities in their lives. Almost 90 percent of them reported that they felt stronger as a result of the program. And 65 percent reported an increased appreciation for life. Though this is a tiny sample, the results indicate that breast cancer survivors who race dragon boats report growth in greater numbers than the one-half to two-thirds of trauma survivors who generally report growth.

In 2011 McDonough published another small study in which she delved further into the experience of dragon boat racing and particularly the social relationships and support that it helped to foster. Since social support is highly correlated with growth, she thought that the relationships might help to explain the large bump in growth she’d found earlier. Oddly, what she found was that these women were not there for support at all. The women were there for something else: to train, to paddle, and to compete. Breast cancer was always in the background, but it was secondary to the team and the sport. “You’re not going on a Thursday night to discuss cancer but going and doing an athletic activity with other cancer survivors., says McDonough. “Now you have a group that you can talk to, the social support is there but it is a secondary pathway to social support. A lot of participants appreciate that the focus in on the athletics. It gives them a positive focus on an activity.” The support is always there if it’s needed, but it’s in a context of positive athletic achievement. And, because these women have been through the same things, they are quick to help and support each other.

These teams are also filled with women who have been through cancer who are fit and healthy and have a positive attitude. They abound with role models, people to aspire to be like, who have found a path to growth and who can show others that they, too, can grow. They are able to have some control over their bodies again, becoming healthy after such long periods of being and feeling unhealthy and weak. “The women don’t say, ‘I’m glad I had breast cancer,” says McDonough. “Instead they say, “Here is something good that has come from this struggle. I might wish it hadn’t happened but something good came from it.”

Since joining the team, Maloney has gone from paddling to becoming a member of the coaching staff to steering the boat and back to paddling. With each move, she has been pushed to learn and change and find new strengths in herself. “One of the things that definitely has emerged in me is that I am a leader. I found it in my professional life and in my personal life alike,” she says. “I think other people’s perception of me has changed a bit, too” says Maloney. “There’s a little bit of respect that I do it, that I commit so much time and work really hard.” She has experienced the joy of competing and winning races. The sport continues to open her up to new experiences and ways of understanding her own capabilities and potential. “The idea that we could go to an international competition, I never thought about that stuff before in my life, but that is possible now.,” she says. “There are new goals being put in front of me and new things for me going up the ladder to higher levels of achievement. And that is exciting.”

EXERCISES TO PRACTICE

The research data presented in Upside emphasizes the importance of creating a coherent narrative about the traumatic event(s), coming to terms with the impact of what happened so that a person can create a new, meaningful narrative of their life going forward.

I teach an exercise in creating a coherent narrative in Bouncing Back workshops, using the format outlined below.

This is what happened.

This is what I did.

This has been the cost.

This is what I learned.

This is what I would do differently going forward.

Creating the new narrative can be done through a journal, through talking with a therapist, through talking with a good friend, even talking with a group of people who have experienced something similar to your experience. The narrative can evolve over time as new learning and new choices emerge. Once you can create a coherent narrative about any life event, you are no longer caught in the grip of the trauma about it; it becomes integrated into an ongoing sense of who you are and how you are going on.

RESOURCES

Upside: The New Science of Post-Traumatic Growth by Jim Rendon. (Available for pre-order for August 2015.

Here’s the link to a recent Resources for Recovering Resilience post I wrote for Greater Good Science Center about How a Challenging Past Can Lead to a Happier Present New research data similar to the data present in Upside.

Man’s Search for Meaning by Viktor Frankl, the classic memoir of finding meaning in the most traumatizing of circumstances, the Nazi death camps in World War II. Frankl’s wisdom about the importance of finding meaning and purpose within the trauma is unsurpassed.