Development of a process model of posttraumatic growth in psychosis: A qualitative study

Introduction: Some people with psychosis experience posttraumatic growth (PTG). PTG is defined as positive psychological changes which occurs after the experience of trauma or adversity, following an emotive struggle with the experience. There is some research into the process and domains of PTG in psychosis. However, limitations of the existing evidence base include a focus on experiences of first-episode psychosis, exclusive inclusion of participants who currently use clinical mental health services, and an emphasis on individual-level facilitators. Increasingly, psychosis is considered as a dimensional construct. The aim of this study was to address these gaps by using a dimensional understanding of psychosis to investigate the process of PTG in psychosis, and to validate the PROSPER framework. Method: Semi-structured qualitative interviews about the experience of PTG were conducted with 25 individuals with diagnosed or self-reported experiences of psychosis who self-identify with having experiences of PTG. Inductive and deductive thematic analysis was used to identify PTG processes, mechanisms and outcomes. Results: Participants described the experience of psychosis as a disruption to an individual's life course, which is moderated by personal and trauma factors. All participants could describe experiences of PTG, but some participants reported difficulty identifying current experiences of PTG, indicating that PTG is a dynamic process. The process from the experience of psychosis to PTG was influenced by two mechanisms: cognitive factors and social/societal factors. All seven domains of the PROSPER framework were validated. Conclusions: Experiencing PTG in psychosis is possible. Further research to quantify the effects of mechanisms utilising longitudinal designs would assist to strengthen the evidence base. Interventions to support PTG in psychosis are indicated, targeting both individual and population levels.