Psychological Trauma: Theory, Research, Practice,

and Policy
Does the Type of Exposure to Traumatic Events Make a Difference in
Posttraumatic Growth?
Fatma Altinsoy and Ayşe Aypay
Online First Publication, November 29, 2021. http://dx.doi.org/10.1037/tra0001173

CITATION
Altinsoy, F., & Aypay, A. (2021, November 29). Does the Type of Exposure to Traumatic Events Make a Difference in
Posttraumatic Growth?. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.
http://dx.doi.org/10.1037/tra0001173
 Psychological Trauma:
Theory, Research, Practice, and Policy
© 2021 American Psychological Association
ISSN: 1942-9681 https://doi.org/10.1037/tra0001173

Does the Type of Exposure to Traumatic Events Make a Difference in

Posttraumatic Growth?

Fatma Altinsoy and Ayse Aypay

Department of Psychological Counselling and Guidance, Eskisehir Osmangazi University

Purpose: The current study tested the predictor roles of psychological hardiness, perceived stress, time
passed through the traumatic event(s), and gender and age on posttraumatic growth in individuals who
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

experienced traumatic events in different ways. Method: A total of 1,132 participants were included in
This document is copyrighted by the American Psychological Association or one of its allied publishers.

seven samples of individuals who had experienced trauma in different ways, such as those who experi-
enced the trauma directly (n = 159); those who witnessed trauma (n = 50); those who have a relative
who had experienced trauma (n = 172); those who were both directly traumatized, and witnessed trauma
(n = 103); those who were both directly traumatized and had a relative who had experienced trauma
(n = 261); those who both witnessed the trauma and have a relative who had experienced trauma (n =
131); and those who directly experienced, witnessed the trauma, and have a relative who had experi-
enced trauma (n = 256). Results: Results have shown that an individual's commitment, which is one
subfactor of hardiness and stress level experienced after traumatic events, predicted posttraumatic
growth in those who have experienced trauma directly only. However, commitment was a single predic-
tor in persons who have learned of the traumatic events experienced by their relative or close friend.
Similarly, commitment and challenge predicted posttraumatic growth in individuals who experienced
direct trauma and learned from their relative or close friend's traumatic experience and in persons who
witnessed and learned about a relative or close friend. Additionally, these two factors were a significant
predictor in a sample of those that experienced three ways of trauma simultaneously. Conclusion: It
seems that regardless of the ways of exposure, hardiness, specifically commitment, plays a crucial role
in individual's transforming traumatic experiences into growth.

Clinical Impact Statement

The current study suggests that the way a person expereiences trauma might have a critical role in
the relationship between psychological hardiness and posttraumatic growth. Specifically, commit-
ment dimension of psychological hardiness predicts posttraumatic growth regardless of traumatic
experience ways.

Keywords: posttraumatic growth, psychological hardiness, the way of traumatic experience

Trauma is a challenging experience (for mental and physical in- include direct exposure to the traumatic event, witnessing the trau-
tegrity) in which the internal potentials of the individual are not matic event in person, learning of a traumatic event happening to a
enough to cope, even for a short time, and therefore produce psy- close family member or friend, or repetitive or excessive exposure
chological and emotional symptoms that spread over time (Briere (e.g., due to professional necessity) to unpleasant details of the
& Scott, 2014; Levine & Frederick, 1997). In the psychiatric ex- traumatic event (American Psychiatric Association [APA], 2013).
amination diagnostic classification system, it is stated that a trau- Accordingly, these undesirable and painful experiences lead to
matic event can be experienced in four ways. These possibilities hissing reactions from those who directly experienced it, as well
as those who witnessed the trauma or the relatives of the victims
(Do
gan, 2014; Kaya, 2019; Levine & Frederick, 1997).
After a traumatic experience, individuals may show stress reac-
Fatma Altinsoy https://orcid.org/0000-0003-4910-2510 tions and develop disorders (Erdur-Baker, 2014); however, this
e Aypay
Ays https://orcid.org/0000-0001-5292-4270 does not apply to every individual because some individuals have
The authors have no conflict of interest. the inner potential to heal themselves, even after the most abrasive
This study was based on a doctoral dissertation and the research was traumatic experiences (Levine & Frederick, 1997). In fact, it has
supported by a Eskis ehir Osmangazi University Research Grant (BAP- been noted that approximately 50% of individuals achieve positive
2019/21A215).
psychological gains after a traumatic experience (Sawyer & Ayers,
Correspondence concerning this article should be addressed to Fatma
Altinsoy, Department of Psychological Counselling and Guidance, Eskisehir 2009). This situation is called posttraumatic growth in psychology
Osmangazi University, 26040- Odunpazarı st., Eskis ehir, Turkey. Email: literature.
[email protected]

1
 2 ALTINSOY AND AYPAY

Posttraumatic growth is the sum of the positive changes that has been exposed to a traumatic event, there are more relational fac-
occur in the functionality of the individual as a result of the strug- tors, such as the way the trauma is reported, the age at which the
gle with stressful and difficult life crises (traumatic experiences) individual learns about this situation, the gender, the current rela-
(Calhoun & Tedeschi, 2006; Tedeschi & Calhoun, 1995). Accord- tionship of the individual with the person experiencing it, and the
ing to the posttraumatic growth model proposed by Calhoun and importance of the person reporting the traumatic event to the indi-
Tedeschi (2006), growth takes place in three basic dimensions: vidual may all play a role in the outcome. Other factors may also
self-perception, relations with others, and life philosophy (Cal- play a role in these processes, such as the risk of losing social sup-
houn & Tedeschi, 2013). port (Nakamura & Tsuchiya, 2020), which has been reported as
In literature, psychological hardiness is pointed out as being the another critical factor in posttraumatic growth. In conclusion, this
defining personality trait that keeps the individual alive after a trau- study aims to investigate the effect of exposure type on the relation-
matic experience and makes it possible for them to turn to growth ship between posttraumatic growth and psychological hardiness.
after trauma (Linley & Joseph, 2004; O’Leary et al., 1998). Psycho- For this purpose, the following hypotheses were tested:
logical hardiness is considered a personality trait when the source H1: Psychological hardiness (commitment, challenge, and con-
of resistance and tension comes up against the tension brought trol) is a significant predictor of posttraumatic growth in individu-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

about by shocking and threatening life events (Kobasa, 1979;

This document is copyrighted by the American Psychological Association or one of its allied publishers.

als exposed to trauma in different ways.

Maddi, 2015). It consists of three components: self-commitment, H2: The stress felt due to trauma is a significant predictor of
which includes a commitment to live, engaging in activities, and posttraumatic growth in individuals exposed to trauma in different
enjoying life; control, which expresses the belief and self-confi- ways.
dence that the individual is in control, despite the problematic expe- H3: Time elapsed after trauma is a significant predictor of post-
rience; and challenge, which is the ability to interpret a difficult traumatic growth in individuals exposed to trauma in different ways.
challenging period of life as an opportunity, rather than avoiding it H4: Gender is a significant predictor of posttraumatic growth in
(Maddi, 2008, 2014; Stein & Bartone, 2020). individuals exposed to trauma in different ways.
Growth is helped by the functions of psychological hardiness, H5: Age is a significant predictor of posttraumatic growth in
posttraumatic self-protection, and personal growth facilitation individuals exposed to trauma in different ways.
(Kobasa, 1979; Maddi, 1987, 2013). Psychological hardiness can
be seen as a personality structure that transforms pain into post-
traumatic growth (Maddi, 2015; Maddi & Harvey, 2006; Salim et
Method
al., 2015). The reported research results clearly show that psycho-
logical hardiness is a key factor in posttraumatic growth (Aflakseir Research Model
et al., 2016; Bartone & Bowles, 2020; Cole & Lynn, 2010). The
This study has been designed according to the correlational
research conducted with individuals who have been exposed to a
model that aims to evaluate the predictor roles of psychological
traumatic event in the literature, has revealed significant relation-
hardiness; time after the trauma and stress; gender; and age on
ships between the challenge dimension of hardiness and posttrau-
posttraumatic growth (Karasar, 2012).
matic growth. This finding clearly shows the importance of
individuals’ having a particular viewpoint, thus enabling them to
see difficulties and obstacles as an opportunity to develop, to get Participants
rid of the negative effects of their trauma, and to grow. The current In the study, these relationships were evaluated in samples of
study aims to reveal whether the effect of psychological hardiness people who had directly experienced the trauma, witnessed the
on posttraumatic growth differs according to the type of exposure trauma, and learned of the trauma experienced by a close relative
to trauma. In addition, the effects of trauma-related stress, duration or friend. Demographic information of the participants was given
of exposure to trauma, and age and gender were also analyzed. in Table 1. In the current study, participants was selected based on
Furthermore, it has been reported that not only the traumatic
their traumatic experiences via “Traumatic Experiences Screening
event itself, but also the type of exposure to the traumatic event is
Form (large T)” (see below for further information of the scale).
important for the individual's mental health. However, how the
Basically, this scale considers traumatic experiences with 12
effect of trauma differs depending on the type of exposure to the
trauma types. Participation was possible if the at least one of these
traumatic event has not been investigated in depth in the relevant
types was experienced.
literature (Wu et al., 2019). In this study, three main types of expo-
The sample was determined according to the sampling criteria:
sure were investigated: direct exposure to trauma, witnessing
having at least one traumatic experience, 18 or older, and volun-
trauma, and learning that a relative had been exposed to trauma.
tary participation. In addition, not having been clinically diag-
Studies on the relationship between psychological hardiness and
nosed with trauma was the exclusion criterion of the study.
posttraumatic growth in individuals directly exposed to trauma
have reported that individual factors such as self-perception, rela-
tionships with others, and life philosophy significantly impact the Measurements
individual (Calhoun & Tedeschi, 2013). In the process of witness- Traumatic Experiences Screening Form (Large T)
ing trauma, in addition to direct individual factors, other individual
factors such as the situational context witnessed, the importance of The Traumatic Experiences Screening Form developed by Altın-
the person exposed to the trauma to the individual, the individual's soy (2020) was used to determine the traumatic experiences of the
mood at the time, and social support, may change the outcome. participants in the study. The form was developed using lists of
Similarly, in cases where an individual learns that a family member traumatic experiences (Foa et al., 1997; Norris, 1990; Wild &
 TRAUMATIC EXPOSURE TYPES AND POSTTRAUMATIC GROWTH 3

Table 1
Demographic Information
Exposure type(s) n %
Direct (n = 159) Gender Female 106 66.7
Male 53 33.3
Age (18–34)  = 20.88, SD = 2.91
X
Time–after trauma (month)  = 6.00, SD = 3.72
X
Trauma dependent stress X = 12.82, SD = 11.41
Witness (n = 50) Gender Female 26 52
Male 24 48
Age (18–30) X = 21.02, Sd = 3.85
Time–after trauma (month)  = 5.38, Sd= 3.46
X
Trauma dependent stress X = 12.08, SD = 12.79
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Learner (n = 172) Gender Female 136 79.1

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Male 36 20.9
Age (18–33) X = 20.44, Sd = 2.13
Time–after trauma (month)  = 5.80, V= 4.50
X
Trauma dependent stress X = 13.09, SD = 12.29
DirectþWitness (n = 103) Gender Female 70 68
Male 33 32
Age (18–36)  = 20.91, SD = 1.93
X
(Direct) Time–after trauma (month)  = 6.62, SD = 4.37
X
(Direct) Trauma dependent stress X = 13.32, SD = 10.97
(Witness) Time–after trauma (month)  = 4.98, SD = 3.88
X
(Witness) Trauma dependent stress  = 9.60, SD = 7.97
X
DirectþLearner (n = 261) Gender Female 186 71.3
Male 75 28.7
Age (18–30)  = 20.66, SD = 2.18
X
(Direct) Time–after trauma (month) X = 5.90, SD = 4.57
(Direct) Trauma dependent stress  = 11.81, SD = 8.16
X
(Learner) Time–after trauma (month) X = 5.39, SD = 3.81
(Learner) Trauma dependent stress  = 11.76, SD = 9.29
X
WitnessþLearner (n = 131) Gender Female 96 73.3
Male 35 26.7
Age (18–36) X = 20.55, Sd = 1.50
(Witness) Time–after trauma (month)  = 5.22, SD = 3.99
X
(Witness) Trauma dependent stress  = 9.82, SD = 7.46
X
(Learner) Time–after trauma (month)  = 6.88, SD = 5.02
X
(Learner) Trauma dependent stress X = 14.42, SD = 10.82
DirectþWitnessþLearner (n = 256) Gender Female 182 71.1
Male 74 28.9
Age (18–36)  = 20.77, SD = 2.27
X
(Direct) Time–after trauma (month) X = 5.75, SD = 3.36
(Direct) Trauma dependent stress  = 12.55, SD = 7.65
X
(Witness) Time–after trauma (month) X = 5.30, SD = 3.58
(Witness) Trauma dependent stress  = 11.27, SD = 7.06
X
(Learner) Time–after trauma (month) X = 6.26, SD = 4.06
(Learner) Trauma dependent stress  = 13.77, SD = 8.69
X

Paivio, 2004) and literature reviewing traumatic experiences (Lev- stress that occurs after a traumatic experience, and they were asked
ine & Frederick, 1997). It contains 12 events (serious illness, acci- to rate it on a scale between 1 and 10 (1 = I had very little stress, 10
dent, natural disaster, loss, fire, violence, sexual abuse, physical = I had excessive stress). To determine how much time had passed
assault, war, detention, suicide, and poisoning requiring medical since the traumatic event, the participants were asked to mark the
intervention) that meet the definition and criteria of traumatic events appropriate option from among the 0–6 months, 6 months-12
in DSM–V (American Psychiatric Association, 2013). Also, the months, 1–3 years, and 3 years and above options.
form can classify the ways of experiencing traumatic experiences
Psychological Hardiness Scale
into three different categories: directly experiencing trauma, wit-
nessing trauma, and learning what has happened to a relative. The The scale developed by Isık (2016) to evaluate hardiness has 21
perceived stress based on trauma and the time elapsing after the items in total and three subdimensions: commitment, control, and
traumatic event were also collected through this form. The partici- challenge. An increase in the scores obtained from the scale means
pants were asked a single-item question to determine the level of an increase in the level of psychological hardiness. The internal
 4 ALTINSOY AND AYPAY

consistency coefficient calculated for the commitment subscale is traumatic event and learned about the traumatic experience of a
.71, control subscale is .74, challenge subscale is .72, and the relative (X = 19.64, SD = 3.86). while the lowest mean score is
whole scale is .77 in this study. in the sample of people who experienced trauma directly only
(X = 18.92, SD = 3.95). Considering the mean scores from the
Posttraumatic Growth Inventory control subdimension of psychological hardiness, it can be seen
The scale was developed by Tedeschi and Calhoun (1996) to that the highest average score is only in the sample of people who
assess posttraumatic change, and later Tedeschi et al. (2017) re- witnessed a traumatic event (X = 20.80, SD = 3.68), whereas the
vised it by (PTG-X) and increased it to 25 items. The scale is eval- lowest mean score belongs to the sample of individuals who both
uated in five subareas: spiritual and existential change, life witnessed a traumatic event and learned about the traumatic expe-
appreciation, personal strength, new opportunities, and relations rience of a relative (X = 20.08, SD = 3.30). When the average
with others. The internal consistency coefficient calculated for the scores from the challenge subdimension of psychological hardi-
whole scale in this study is .84. ness are evaluated, the highest average score is observed in the
sample of people who experienced all three types of trauma expo-
sure (X = 23.45, SD = 3.02), while the lowest mean score
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Analysis
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belongs to the sample of people who witnessed a traumatic event

The data collected within the scope of the research was tested only (X = 21.98, SD = 4.04).
with IBM SPSS 21 program. Pearson correlation coefficient and Relationships between trauma experiences, duration of trauma
multiple linear regression analysis techniques were used to deter- experiences, posttraumatic growth, gender, and age variables of
mine the relationships between variables. Before the analysis, the participants who experienced trauma, witnessed and attended to
distribution of the data was evaluated for all sample groups. Kurto- their relatives in participant samples were evaluated with Pearson
sis values were between –.062 and –.440. It was determined that correlation coefficient. Analysis results are given in Table 3.
the skewness values were between –.099 and –.421, and these val- In the participant samples, which includes dual combinations of
ues were within acceptable limits (Tabachnick & Fidell, 2013). traumatic experiences such as the direct experience of trauma, wit-
This researched was approved by the university ethical committee nessing, and learning of a relative's experience, the relationships
(20.11.2018/64075176-050.99-E.122348). This study is part of the between participants' trauma experiences, the stress level felt due
project and in this project series studies were run. to trauma, posttraumatic growth, psychological hardiness subdi-
The dependent variable of the current study was posttraumatic mensions, and age variables were evaluated with the Pearson cor-
growth, and it was assessed generally instead of with subareas, while relation coefficient. Analysis results are given in Table 4.
the independent variables were psychological hardiness dimensions In the sample of participants who have experienced all three of
(commitment, control, and challenge), traumatic related variables the trauma experiences, such as the direct experience of trauma,
(stress, time), and demographic information (age and gender). witnessing, and learning of a relative's experience, the relationship
between the time passed after the trauma, the level of stress felt
Results due to the trauma, posttraumatic growth, and psychological hardi-
ness subdimensions were evaluated with the Pearson correlation
The average and standard deviation scores obtained on the post- coefficient. Analysis results are given in Table 5.
traumatic growth and psychological hardiness dimensions by The predictiveness of psychological hardiness, time after trauma,
trauma exposure type are shown in Table 2. stress felt due to trauma, gender and age of the participants with
When the average scores in Table 2 are considered, the highest various types of trauma exposure on posttraumatic growth were
mean score of posttraumatic growth was observed in the group tested, and the analysis results are given in Tables 6, 7, and 8.
that was both directly exposed to and witnessed a traumatic event According to Table 6, the psychological hardiness and commit-
(X = 81.63, SD = 13.06), while the lowest mean score came ment subdimension scores of the participants who directly experi-
from those who only witnessed a traumatic event (X = 76.30, SD = enced trauma (b = .42, p , .01), and the level of stress they felt
15.44). Looking at the average scores regarding the commitment after their trauma experiences (b = .25, p , .01) significantly pre-
subdimension of psychological hardiness, it is clear that the high- dicts their posttraumatic growth and the regression model explains
est mean score is in the sample of people who witnessed a approximately 31% of the variance. Psychological hardiness

Table 2
Psychological Hardiness and Posttraumatic Growth Mean and Standard Deviation Scores
Exposure type(s)
Direct þ
Witness þ
Direct Witness Learner Direct þ Witness Direct þ Learner Witness þ Learner Learner
Variables X SD 
X SD 
X SD 
X SD 
X SD 
X SD 
X SD
Posttraumatic growth 80.21 15.28 76.30 15.44 79.20 12.84 81.63 13.06 78.32 15.03 80.68 14.20 81.12 14.08
Commitment 18.92 3.95 19.26 4.56 19.51 3.64 19.31 4.20 19.17 3.96 19.64 3.86 19.22 3.58
Control 20.14 3.78 20.80 3.68 20.33 3.50 20.11 3.44 20.09 3.51 20.08 3.30 20.18 3.61
Challenge 22.89 3.64 21.98 4.04 23.02 3.30 23.31 3.58 23.28 3.02 22.61 3.25 23.45 3.02
Note. Bold values show the highest and lowest average scores.
 TRAUMATIC EXPOSURE TYPES AND POSTTRAUMATIC GROWTH 5

Table 3 Discussion
Correlations Among Variables–Single Exposure Way
This study tested whether the variables of psychological hardi-
Direct (n = 159) ness (commitment, challenge, and control), perceived stress, time,
Variables 1 2 3 4 5 6
and gender and age, predicted posttraumatic growth in individuals
who experienced different forms of exposure to various traumatic
1. Posttraumatic growth — events. In individuals directly exposed to a traumatic event, com-
2. Commitment .48** —
3. Control .33** .46** — mitment and traumatic stress (which are the subdimensions of psy-
4. Challenge .31** .40** .39** — chological hardiness) predict posttraumatic growth, and in
5. Time .05 .08 .05 .05 — individuals learning that their family or close relatives have been
6. Stress .15* .14 .04 .01 .51** — exposed to a traumatic event, commitment (only one of the subdi-
7. Age .06 .08 .12 .01 .02 .01
mensions of psychological hardiness), predicts posttraumatic
Witness (n = 50) growth. In individuals who witnessed a traumatic event, psycho-
1. Posttraumatic growth —
logical hardiness, length of time elapsed after trauma, stress felt
2. Commitment .23 —
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3. Control .23 .37** — due to trauma, and gender and age were not significant predictors
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4. Challenge .38** .39** .52** — of posttraumatic growth. As for individuals who have experienced
5. Time .25 .30* .08 .21 — multiple types of trauma, all subdimensions of psychological har-
6. Stress .1 .07 .01 .01 .07 — diness (commitment, control, and challenge) were found to be sig-
7. Age .11 .19 .02 .12 .41** .55**
nificant predictors of posttraumatic growth in individuals who
Learner (n = 172) have both witnessed and been directly exposed to trauma. It was
1. Posttraumatic growth —
2. Commitment .40** —
further determined that commitment and challenges are a signifi-
3. Control .24** .34** — cant predictor of posttraumatic growth in individuals who have
4. Challenge .27** .44** .33** — learned about a relative's experience of trauma and have been
5. Time .06 .1 .03 .03 — directly exposed to trauma; and similarly, commitment and chal-
6. Stress .07 .07 .01 .12 .69** — lenge, which are subdimensions of psychological hardiness, are
7. Age .17* .22** .01 .01 .03 .14
significant predictors of posttraumatic growth in individuals who
* p , .05. ** p , .01. have witnessed trauma and learned that a relative was exposed to
trauma. Additionally, it was observed that the commitment and
commitment subdimension scores of the participants who learned challenge subdimensions of psychological hardiness were signifi-
from one who experienced the trauma (b = .27, p , .01) signifi- cant predictors of posttraumatic growth in individuals who had
cantly predicts their posttraumatic growth, and the regression model experienced all three types of trauma. Overall, the commitment
explains about 20% of the variance. It was observed that the dimension of psychological hardiness is a fundamental variable
ANOVA test for the regression analysis performed in the sample of predicting posttraumatic growth in all combinations of exposure to
traumatic events.
individuals who witnessed trauma was not statistically significant.
Studies conducted with individuals directly exposed to trauma
As shown in Table 7, the psychological hardiness of the partici-
(e.g., sexual abuse) highlight that hardiness is an important predictor
pants who experienced trauma both directly and as witnesses (b =
of posttraumatic growth and correlates with it positively (Aflakseir et
.39, p , .01), control (b = .24, p , .01), and challenge subscale
al., 2016; Bartone & Bowles, 2020; Cole & Lynn, 2010). Few studies
scores (b = .20, p , .01) significantly predicted their posttraumatic
highlight the link between psychological hardiness, commitment and
growth and the regression model explains approximately 42% of the
growth. For example, in a study conducted with adult individuals
variance. The psychological hardiness of the participants, who both
diagnosed with cancer, significant relationships were found between
directly experienced the trauma and learned from one who experi-
hardiness, commitment, and posttraumatic growth (Cies¨lak et al.,
enced the trauma was (b = .35, p , .01), and challenge subdimension 2017). Similar results were obtained in a study of a sample of young
scores (b = .21, p , .01) significantly predicted their posttraumatic adults injured in sports (Salim et al., 2015), showing that individuals
growth and the regression model explains about 27% of the variance. with high self-dedication have a high probability of posttraumatic
The psychological hardiness of the participants who have both wit- growth, regardless of how they have been exposed to the traumatic
nessed the trauma and learned about a relative who has experienced experience. Thus, dedication (commitment) appears to be the “golden
trauma (b = .41, p , .01) and challenge subdimension scores (b = rule” for growing after a traumatic experience.
.21, p , .01) significantly predicts their posttraumatic growth and the Another notable result obtained in this study is that the challenge
regression model explains approximately 29% of the variance. dimension of psychological hardiness is a secondary variable
As show in Table 8, in the sample of participants who have explaining posttraumatic growth in double and triple exposure to
experienced all three types of trauma (having had direct experi- traumatic events. The research conducted with individuals who have
ence, witnessed a traumatic event, and learning of their relative's been exposed to a traumatic event in the literature has revealed sig-
trauma), the psychological hardiness of the participants is (b = .36, nificant relationships between the challenge dimension of hardiness
p , .01) and the challenge subscale scores (b = .21, p , .01) sig- and posttraumatic growth. The findings of a study conducted with
nificantly predicted their posttraumatic growth. The regression young athletes with physical injuries (Salim et al., 2015) and another
model explains approximately 31% of the variance. In regression study conducted with adults diagnosed with cancer are examples of
models in which significant effects were determined, it was this relationship. However, this study tested the predictability of
observed that the significance continued in bootstrap samples. multiple exposures to trauma. While the control dimension of
 6 ALTINSOY AND AYPAY

Table 4
Correlations Among Variables–Double Trauma
Direct1 þ Witness2 (n = 103)
Variables 1 2 3 4 5 6 7 8
1. Posttraumatic growth —
2. Commitment .51** —
3. Control .43** .40** —
4. Challenge .42** .31** .46** —
5. Time1 .05 .01 .16 .08 —
6. Stress1 .01 .08 .19 .04 .85** —
7. Time2 .11 .02 .14 .03 .01 .05 —
8. Stress2 .06 .08 .06 .05 .13 .20* .52** —
9. Age .07 .04 .13 .03 .03 .02 .13 .02
Direct1þ Learner2 (n = 261)
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1. Posttraumatic growth —
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2. Commitment .44** —
3. Control .23** .35** —
4. Challenge .32** .30** .31** —
5. Time1 .13* .08 .01 .05 —
6. Stress1 .10 .03 .02 .00 .61** —
7. Time2 .10 .17** .05 .04 .14* .14* —
8. Stress2 .12* .14* .12 .03 .10 .24** .66** —
9. Age .14* .14* .02 .08 .09 .15* .08 .10
Witness1 þ Learner2 (n = 131)
Variables 1 2 3 4 5 6 7 8
1. Posttraumatic growth —
2. Commitment .45** —
3. Control .17* .43** —
4. Challenge .32** .35** .42** —
5. Time1 .06 .14 .12 .02 —
6. Stress1 .04 .08 .11 .03 .57** —
7. Time2 .21* .17 .05 .03 .13 .11 —
8. Stress2 .21* .05 .01 .02 .09 .14 .66** —
9. Age .10 .12 .12 .09 .03 .11 .07 .03
Note. 1 Values for the first trauma type exposed; 2 Values for the second type of trauma exposed.
* p , .05. ** p , .01.

psychological hardiness did not significantly predict posttraumatic combination, significantly predicted posttraumatic growth in all four
growth in three combinations (direct-relative; witness-relative; combinations addressed in this study. This finding clearly shows the
direct-witness-relative), including double or triple exposure to importance of individuals having a particular viewpoint thus ena-
trauma, the challenge dimension, including the directly-witness bling them to see difficulties and obstacles as an opportunity to

Table 5
Correlations Among Variables–Triple Exposure Way
Direct1 þ Witness2 þ Learner3 (n = 256)
Variables 1 2 3 4 5 6 7 8 9 10
1. Posttraumatic growth —
2. Commitment .48** —
3. Control .33** .44** —
4. Challenge .38** .39** .34** —
5. Time1 .06 .06 .01 .02 —
6. Stress1 .08 .07 .06 .03 .76** —
7. Time2 .07 .05 .00 .00 .07 .02 —
8. Stress2 .09 .07 .02 .00 .11 .18** .75** —
9. Time3 .09 .05 .01 .02 .12* .03 .12 .07 —
10. Stress3 .10 .02 .03 .08 .05 .07 .00 .08 .80** —
11. Age .10 .09 .07 .02 .07 .12 .14* .12* .11 .03
Note. Direct1 = Directly experiencing trauma; Witness2 = Witnessing trauma; Learner3 = Learning what has happened to a rel-
ative. Time1 : (Direct) Time – After trauma (Month); Stress1 = (Direct) Trauma Dependent Stress; Time2 = (Witness) Time –
After trauma (Month); Stress2 = (Witness) Trauma Dependent Stress; Time3 = (Learner) Time – After trauma (Month); Stress3 =
(Learner) Trauma Dependent Stress.
* p , .05. **p , .01.
 TRAUMATIC EXPOSURE TYPES AND POSTTRAUMATIC GROWTH 7

Table 6
Multiple Hierarchical Regression Analysis Result-Single Trauma
Direct (n = 159) Witness (n = 50) Learner (n = 172)
Bootstrap Bootstrap Bootstrap
Variables B SH b t p Bias p B SH b t p Bias p B SH b t p Bias p
Constant 26.89 1.41 2.58 .01 .10 .03 27.01 17.48 1.55 .13 12.46 .23 23.85 11.59 2.06 .04 .00 .04
Gender* .51 2.29 .02 .22 .82 .13 .83 6.23 4.22 .20 1.48 .15 .33 .16 2.68 2.25 .09 1.19 .24 .01 .25
Age .05 .36 .01 .13 .90 .04 .90 .66 .64 .16 1.03 .31 .53 .41 .75 .45 .12 1.68 .10 .01 .07
Commitment 1.63 .31 .42 5.22 .00 .03 .00 .17 .53 .05 .32 .75 .04 .76 .96 .30 .27 3.21 .00 .01 .00
Control .45 .32 .11 1.38 .17 .03 .23 .10 .69 .02 .15 .89 .15 .90 .43 .28 .12 1.53 .13 .02 .09
Challenge .43 .33 .10 1.33 .19 .03 .19 1.14 .64 .30 1.79 .08 .02 .11 .45 .32 .12 1.42 .16 .02 .16
Time .21 .34 .05 .62 .54 .13 .64 .59 .74 .13 .79 .43 .20 .42 .10 .28 .04 .36 .72 .07 .73
Stress .33 .11 .25 3.09 .00 .07 .05 .10 .22 .08 .44 .66 .08 .67 .03 .11 .02 .23 .82 .04 .86
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F 9.61 1.79 5.96

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R2 .31 .23 .20

Note. Direct = Directly experiencing trauma; Witness = Witnessing trauma, Learning: Learning what has happened to a relative; Bootstrap = 1,000 sam-
ples. Bold lines indicate significant relationship.
* female = 1, male = 0.

develop, to get rid of the negative effects of their trauma, and to self-confidence in affecting and controlling the consequences of the
grow (Maddi, 2015; Maddi & Harvey, 2006); therefore, developing traumatic event they have experienced. This finding points out the
an effective coping attitude that will shape their behaviors by taking importance of gaining awareness that individuals can use to direct
this point of view. their lives by striving for the results they want from an early age.
The findings show that the control dimension of hardiness is a The findings show that the degree of stress perceived by the par-
third-order variable explaining posttraumatic growth in the form of ticipants who were directly exposed to trauma (between 1 and 10)
dual exposure (direct and witnessing) to traumatic events. Because after a traumatic experience predicted their posttraumatic growth
most of the studies in the literature conducted on psychological har- in a significant and positive way. Posttraumatic growth involves
diness are based on the total score, only two studies were identified both stress and growth at the same time like a paradox (Tedeschi
as focusing on the relationship between the control dimension and & Calhoun, 2004; Tedeschi & Moore, 2016). From the positive
posttraumatic growth. In one of these studies, the control subdimen- psychology approach, considering that stress caused by traumatic
sion was found to be associated with posttraumatic growth (Salim experience is an overstretched state of metabolism may serve to
et al., 2015), while in the other (Cies¨lak et al., 2017) no relation- make the individual leap spiritually, much like the situation where
ship was found between these two variables. A controlling attitude, a spring is pulled backward quickly, and the arrow is thrown for-
which expresses the ability to overcome the tension arising from ward. In the first look, some experiences could be considered as
the life-changing event and to transform the negative consequences “destructive” but they can also help individuals to gain strength.
of the event to the desired direction (Maddi, 1999) may contribute This idea is similar to “what doesn't kill me makes me stronger.”
to posttraumatic growth by ensuring that individuals maintain their Having said that, however, literature findings on the relationship

Table 7
Multiple Hierarchical Regression Analysis Result-Double Trauma
Direct1 þ Witness2 (n = 103) Direct1 þ Learner2 (n = 261) Witness1 þ Learner2 (n = 131)
Bootstrap Bootstrap Bootstrap
Variables B SH b t p Bias p B SH b t p Bias p B SH b t p Bias p
Constant 13.05 14.35 .91 .37 .47 .33 8.43 1.91 .77 .44 .79 .54 29.65 16.61 1.79 .08 .98 .06
Gender* 2.47 2.47 .09 1.00 .32 .08 .32 .95 1.85 .03 .51 .61 .02 .63 3.86 2.56 .12 1.51 .13 .17 .12
Age .47 .55 .07 .86 .39 .05 .33 .69 .39 .10 1.79 .08 .02 .24 .31 .74 .03 .42 .67 .04 .64
Commitment 1.20 .28 .39 4.28 .00 .02 .00 1.32 .24 .35 5.59 .00 .02 .00 1.50 .33 .41 4.57 .00 2.02 .00
Control .89 .37 .24 2.39 .02 .01 .03 .21 .26 .05 .80 .42 .00 .45 .31 .39 .07 .78 .44 .04 .47
Challenge .74 .34 .20 2.20 .03 .00 .01 1.05 .30 .21 3.55 .00 .01 .00 .91 .38 .21 2.39 .02 2.02 .02
Time1 .49 .50 .17 .99 .33 .04 .28 .22 .23 .07 .97 .33 .02 .35 .17 .41 .05 .41 .68 .10 .73
Stress1
.27 .20 .23 1.36 .18 .03 .17 .03 .13 .02 .23 .82 .00 .84 .12 .22 .06 .55 .58 .04 .66
Time2 .37 .34 .11 1.11 .27 .06 .22 .07 .29 .02 .23 .82 .00 .83 .06 .37 .02 .15 .88 .03 .90
Stress2 .06 .17 .04 .36 .72 .01 .66 .10 .12 .06 .77 .44 .01 .41 .25 .17 .19 1.48 .14 .01 .23
F 7.32 1.11 5.55
R2 .42 .27 .29
1 2
Note. Values for the first trauma type exposed; Values for the second type of trauma exposed. Bold lines indicate significant relationship. Bootstrap =
1,000 samples.
* female = 1, male = 0.
 8 ALTINSOY AND AYPAY

Table 8
Multiple Hierarchical Regression Analysis Result-Triple Trauma
Direct1 þ Witness2 þ Learner3(n = 256)
Bootstrap
Variables B SH b t p Bias p
Constant 15.15 9.55 1.59 .11 .17 .09
Gender* 1.05 1.73 .03 .61 .55 .13 .57
Age .22 .35 .04 .62 .54 .01 .49
Commitment 1.43 .25 .36 5.71 .00 .01 .00
Control .37 .24 .09 1.53 .13 .00 .20
Challenge .98 .28 .21 3.47 .00 .01 .00
Time1 .00 .37 .00 .01 .99 .01 .99
Stress1 .04 .17 .02 .25 .80 .00 .83
Time2
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.01 .35 .00 .02 .98 .00 .99

Stress2 .01
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.20 .18 .10 1.13 .26 .32

Time3 .19 .35 .06 .55 .59 .01 .61
Stress3 .04 .16 .02 .23 .82 .01 .82
F 9.85
R2 .31
Note. Direct = Directly experiencing trauma; Witness2 = Witnessing trauma, Learner3 = Learning what has
1

happened to a relative; Time1 = (Direct) Time – After trauma (Month); Stress1 = (Direct) Trauma Dependent
Stress; Time2 = (Witness) Time – After trauma (Month); Stress2 = (Witness) Trauma Dependent Stress;
Time3 = (Learner) Time – After trauma (Month); Stress3 = (Learner) Trauma Dependent Stress. Bold lines
indicate significant relationship. Bootstrap = 1,000 samples.
* female = 1, male = 0.

between stress and posttraumatic growth present conflicting results. growth with a broader age range of individuals with different
There is a positive relationship between stress level and posttrau- trauma experiences.
matic growth (Martin et al., 2017). There is evidence that either this Likewise, in the present study, no significant relationship was
is true or moderate stress is associated with higher posttraumatic found between time passed after a traumatic experience and post-
growth (Colville & Cream, 2009; Kardas  & Tanhan, 2018). How- traumatic growth in all combinations of different exposure styles
ever, there is no significant relationship between growth and emo- to traumatic events. The research findings regarding the relation-
tional stress (Rosenbach & Renneberg, 2008). The reason for the ship between time after trauma and posttraumatic growth are con-
differentiation of the findings may be related to the level of the indi- tradictory as well. In their study of Japanese university students
vidual’s understanding of trauma and its effect on their life. with traumatic experiences, Taku et al. (2007) found no significant
In the current study, no significant relationship was found relationship between the time elapsed after trauma and posttrau-
between age and posttraumatic growth in all combinations of dif- matic growth. However, some studies suggest that growth is more
ferent exposure styles to traumatic events. There are many con- likely to occur as time passes after the traumatic experience (Akın,
flicting findings in the literature regarding the relationship between 2019; Powell et al., 2007; Ülbe & Kartal, 2019) while others sug-
age and posttraumatic growth. The studies conducted on samples gest that growth is more likely if the period is shorter (Kalpakjian
of adults with different traumatic experiences report that the age et al., 2014). In related literature, varying results regarding the
variable does not have predictive power on posttraumatic growth relationship between posttraumatic growth and time-lapsed after
(Bartone & Bowles, 2020; Kaplan-Kalkan, 2020). However, some trauma show that the time factor alone is not sufficient for post-
studies indicate that a young age factor is a predictor of posttrau- traumatic growth, and they indicate that the journey of posttrau-
matic growth and younger people report more growth experiences matic growth is shaped according to the presence or absence of
than their elders (Kalpakjian et al., 2014; Polatinsky & Esprey, some mediating variables (e.g., coping skills, social support)
2000; Widows et al., 2005). The finding in the present study that accompanying the posttraumatic time. In the present study, the
the age variable does not have a significant predictive effect may time elapsed after trauma is similar in all subsamples. Longer
stem from the fact that the research sample consists only of young lapse of time after trauma may have different results in terms of
adults (see Table 1). In all subsamples, the ages of the participants posttraumatic growth in individuals with different types of trauma
ranged from 18 to 36. Some studies have found that older partici- exposure.
pants reported higher growth than younger participants (Tallman Finally, this study did not show a significant change between
et al., 2010; U
gurluo
glu & Erdem, 2019). Considering the age gender and posttraumatic growth in all combinations of different
ranges of the individuals in the current study sample it can be exposure styles to traumatic events. There are some conflicting
stated that it is difficult to observe the age-related change in post- findings in the literature regarding the relationship between gender
traumatic growth because it only covers one period of psychoso- and posttraumatic growth. Although there are other findings sup-
cial development. In this sense, it can be stated that the age porting this conclusion (Polatinsky & Esprey, 2000), in some stud-
variable was not expected to have a significant predictive effect in ies, women reported more growth (Akın, 2019; Kalpakjian et al.,
this study. Further studies are needed to investigate posttraumatic 2014; Linley & Joseph, 2004; Rosenbach & Renneberg, 2008;
 TRAUMATIC EXPOSURE TYPES AND POSTTRAUMATIC GROWTH 9

Tedeschi & Calhoun, 1996). These different results may arise Cies¨lak, M., Jakitowicz, K., Kozaka, J., Bidzan, M., & Ki_zewska, A.
from both the cultural role as well as gender roles in which the (2017). Twardos¨c psychiczna i wsparcie społeczne a wzrost pourazowy
individual is trained and individual dimensions such as coping u chorych z nowotworem–doniesienie wste˛pne [Hardiness, social sup-
skills. port, and posttraumatic growth among oncological patients—preliminary
Although it may be considered a limitation that this study has report]. Psychoonkologia, 21(1), 22–28. https://doi.org/10.5114/pson
.2017.70124
been conducted with only one group (individuals who continue
Colville, G., & Cream, P. (2009). Post-traumatic growth in parents after a
their undergraduate education), it provides unique contributions to
child’s admission to intensive care: Maybe Nietzsche was right? Inten-
the field in terms of providing information about posttraumatic sive Care Medicine, 35(5), 919–923. https://doi.org/10.1007/s00134-009
growth, psychological hardiness attitudes, perceived stress due to -1444-1
trauma, and relationship patterns between age, time, and gender Cole, A. S., & Lynn, S. J. (2010). Adjustment of sexual assault survivors:
variables in individuals with a traumatic experience. In addition, Hardiness and acceptance coping in post-traumatic growth. Imagination,
we believe it is a contributing study to the field in terms of present- Cognition and Personality, 30(1), 111–127. https://doi.org/10.2190/IC
ing comparative findings regarding different exposure styles to .30.1.g
traumatic events. Accordingly, the findings of this study reveal
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Do
gan, T. (2014). Yardım edenlere yardım: Yardım edenlerde travmatik

This document is copyrighted by the American Psychological Association or one of its allied publishers.

functional information for mental health professionals and stres tepkileri ve iyilik halinin korunması [Helping those who help:
researchers. The primary finding of this study is that, independent Traumatic stress reactions and maintaining well-being in those who
from trauma exposure type, the commitment aspect of psychologi- help]. In Ö. Erdur-Baker & T. ve Do
gan (Eds.), A fetler, krizler travma-
lar ve psikolojik yardım [Disasters, crises, traumas and psychological
cal hardiness is a strong predictor of posttraumatic growth. Profes-
help] (pp. 289–314). Türk PDR Derne
gi Yayınları.
sionals who provide mental health services to individuals with
Erdur-Baker, Ö. (2014). Afetler, krizler, travmalar ve travmatik stres tepki-
traumatic experience can use this information in the consultation
leri [Disasters, crises, traumas and traumatic stress responses]. In Ö.
process to strengthen the commitment of their clients. There is a Erdur-Baker & T. ve Do
gan (Eds.), Afetler, krizler travmalar ve psikolo-
definite need for experimental studies on this subject as well. Clin- jik yardım [Disasters, crises, traumas and psychological help] (pp.
ical trials based on positive psychology and working with those 3–24). Türk PDR Derne
gi Yayınları.
who have traumatic experience should consider not only type of Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of
traumatic events, but also the way of traumatic experience a per- a self-report measure of post-traumatic stress disorder: The post-trau-
son gets. Finally, this study is correlational and presents descrip- matic diagnostic scale. Psychological Assessment, 9(4), 445–451.
tive findings. Therefore, the exact role of different types of https://doi.org/10.1037/1040-3590.9.4.445
exposure to traumatic events in life can be examined through lon- ık, S
Is  . (2016). Psikolojik dayanıklılık ölçe
gi’nin gelistirilmesi: Geçerlik
gitudinal studies. ve güvenirlik çalısması [Development of psychological hardiness scale:
Validity and reliability study]. The Journal of Happiness & Well-Being,
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