Can People Experience Post-Traumatic Growth after Committing Violent Acts ?

1 Can People Experience Post-Traumatic Growth after Committing Violent Acts? Laura E. R. Blackie Department of French and Francophone Studies, University of Nottingham, UK Ann Marie Roepke Positive Psychology Center, University of Pennsylvania, USA Nicki Hitchcott Department of French and Francophone Studies, University of Nottingham, UK Stephen Joseph School of Education, University of Nottingham, UK Accepted for publication in Peace and Conflict: Journal of Peace Psychology. Published by American Psychological Association and Taylor & Francis (Routledge). This article may not exactly replicate the final version published in the APA journal. It is not the copy of record. A link to the published article: http://dx.doi.org/10.1037/pac0000218


Defining Post-Traumatic Growth:
Theories of post-traumatic growth provide a framework to explain how the struggle with stressful and often traumatic experiences can lead to positive changes in individuals' identities, relationships and life priorities. In response to a wide array of distressing events including life-threatening illnesses, natural disasters, and violent/sexual acts of victimisation, some individuals have reported a greater connection with their loved ones, an enhanced sense of personal strength and a new understanding of what is important in their lives (Tedeschi & Calhoun, 2004). Post-traumatic growth can be viewed as a narrative transformation insofar as the individual's perception of himself or herself changes from being a "victim" of trauma to a "survivor" of trauma (Tedeschi, 1999). Thus, it is not surprising that discussions about how an experience of violence can function as a catalyst for growth generally focus on survivors of violent victimisation, not perpetrators. This is understandable given our natural tendency to empathise with victims of tragic and uncontrollable circumstances, and given that theories of post-traumatic growth were developed against the backdrop of PTSD research (Joseph & Linley, 2005), which at least historically has also focused on cases of victimization (Litz et al., 2009). However, with research demonstrating an association between PTSD and violence committed during active service (MacNair, 2015), there is a need to integrate divergent theories to understand the psychological processes of recovery, resilience, and post-traumatic growth in this population.

Aim of the Current Article:
The aim of this article is to propose a tentative model outlining the conditions under which people may experience post-traumatic growth after committing violent acts. We write about this topic with some trepidation, given that conceptions of post-traumatic growth often imply that an individual's post-trauma identity is "better," "stronger", or in some way superior to their previous self. Our intention is not to condone violence, assert that it makes people better, or romanticise the painful challenges that some people struggle with after committing violent acts. Instead, our article draws on existing parallels between research into moral injury (Litz et al., 2009) and post-traumatic growth (Tedeschi & Calhoun, 2004) in an effort to stimulate dialogue and empirical research into the psychological processes involved in the recovery and rehabilitation of those who commit acts of violence. Given the brevity of this article, we focus on a specific population: military personnel who perpetrate violence during active service. We have limited our scope for two reasons. First, there is research into moral injury and post-traumatic growth in this population, providing opportunities for the integration and expansion of existing theories. Second, although post-traumatic growth may occur in response to other acts of violence, different types of acts will raise unique issues, some of which we explore in our concluding remarks.

Cognitive Dissonance as a Precursor of Post-Traumatic Growth:
Many models of post-traumatic growth were developed from existing social-cognitive models of PTSD, which posit that traumatic experiences can severely challenge individuals' pre-trauma schemas about the world (Joseph & Linley, 2005). For example, an unforeseen and uncontrollable tragedy may cause a person to re-evaluate the belief that the world is a safe and predictable place where good things happen to good people. The resulting seismic challenge to the individual's pre-trauma beliefs is highly distressing and initially he or she struggles to process the trauma, experiencing symptoms of PTSD (e.g., flashbacks and attempts to suppress and avoid trauma-related memories). In order to recover from the trauma and associated distress, the individual must eventually disengage from schemas, goals and beliefs that are no longer applicable to his or her post-trauma reality. It is the transition to a deliberative and effortful processing style that can eventually allow people to rebuild their livesand in some cases identify positive changes that have emerged from their experiences (Tedeschi & Calhoun, 2004).
At the core of such theories of post-traumatic growth is an assumption that individuals have a completion tendency, an innate drive to reconcile information that is incoherent with reality (Joseph & Linley, 2005). The likelihood of post-traumatic growth occurring depends on how the individual reconciles their pre-trauma schemas with post-trauma reality. Joseph and Linley's (2005) theory of post-traumatic growth outlines three possible outcomes: (1) assimilation, (2) negative accommodation, and (3) positive accommodation. 1 Assimilation involves incorporating the trauma into pre-existing schemas and maintaining beliefs such as "the world is safe" and "I control my own destiny". For example, after being violently victimized a person may assimilate the experience by blaming her/himself (e.g., "It was my fault. I wasn't careful enough."). In this situation, the individual's beliefthat we control our own destinyremains unchanged. In contrast, accommodation involves changing old beliefs in light of new information learned through the traumatic ordeal. Beliefs can be revised in either a negative way (e.g., "I have no control over my life. Danger is everywhere") or in a positive and adaptive way (e.g., "I can't control everything, but I can control how I respond to this experience"). Although both processes involve changes in beliefs, positive accommodation can facilitate post-traumatic growth whereas negative accommodation can result in further feelings of distress and hopelessness.
The post-traumatic growth process is, of course, not easy and may take months or years to occur, if it happens at all. There are a number of factors that foster or hinder the process. Most are beyond the scope of this article, but the crucial role of the social environment merits discussion. A supportive environment meeting basic psychological needs (autonomy, competency and relatedness) is integral to facilitating the process of positive accommodation; in an unsupportive environment, individuals lack psychological resources and a safe space to discuss and revise their beliefs, and so tend towards assimilation or negative accommodation (Joseph & Linley, 2005).

Can People Experience Cognitive Dissonance after Committing Violent Acts?
Most theories of post-traumatic growth assume that cognitive dissonance is an important precursor of post-traumatic growth (Joseph & Linley, 2005). The first question we need to address, then, is whether those who commit violence feel such dissonance as a result.
An initial reaction might be 'no' if images of unrepentant, sociopathic killers spring to the reader's mind. We presume that dissonance and post-traumatic growth do not occur in these extreme cases. As shown in Figure 1, unrepentant killers can assimilate their actions within their existing worldviews. This rationalisation may lead to feelings of moral superiority and victim blaming (e.g., a genocide perpetrator who believes that their atrocities are justified because other inferior groups have no place in the world). However, research into moral injury reveals a different outcome when those who commit violent acts feel troubled by their actions: in these cases it is possible that post-traumatic growth may occur.
Moral injury describes the harmful aftermath that can occur when an individual's action (or inaction) violates his/her deeply held beliefs about morality (Litz et al., 2009). It is studied in relation to military personnel and is triggered by either the direct perpetration of violence or through bearing witness to and/or failing to prevent violence. For moral injury to occur an individual must become aware of and distressed by a discrepancy between their actions and their morals. Thus, as in models of post-traumatic growth, the experience of cognitive dissonance is an important precursor to the onset of moral injury (Litz et al., 2009).
The experience of moral injury is accompanied by intense feelings of guilt, shame, anxiety, and anger (Gray et al., 2012), which serve to create and perpetuate the individual's belief that he or she is an immoral and worthless person. Moral injury is a vicious cycle that, if left unaddressed, can lead to social withdrawal and self-destructive behaviours, which reinforce the harmful emotions and beliefs accompanied by experiences of moral injury. This process is outlined in Figure 1. In our diagram, the term "moral injury" includes both the violation of one's moral code and the negative emotions that accompany this violation. We use the term "negative accommodation" to describe the individual's harmful attributions of the transgression to internal, stable and global features of themselves (e.g., "I am an immoral and unworthy person"). To date, models of moral injury have only described the deleterious impact of war, and cannot account for individuals experiencing post-traumatic growth.

When Can Moral Injury lead to Post-Traumatic Growth?
Individuals can heal from moral injury with psychological support and treatment. Litz et al. (2009) describe how their clinical treatment programme can facilitate a process of "moral repair", in which the individual is able to "…reclaim good parts of themselves and to examine and acceptbut not be defined bywhat they did, what they saw, what others did, and so forth" (p.703). This description allows for more than a simple notion of repair, a return to the status quo; it also points to how an individual can ultimately develop a more flexible and functional belief system. This same theme is seen in models of post-traumatic growth, as in both cases the resolution of a trauma can lead to a revision of pre-trauma schemas and a more flexible, helpful set of beliefs.
Furthermore, emerging empirical research involving military personnel supports the idea that moral injury may in some cases foster post-traumatic growth. For instance, Dekel, Mamon, Solomon, Lanman, and Dishy (2016) found that greater guilt-induced distress in veterans from the 1973 Yom Kippur War was related to an increase in post-traumatic growth over time, demonstrating that a core emotion in moral injury is predictive of post-traumatic growth. Gray et al. (2012) found that the treatment of moral injury with Adaptive Disclosure therapy reduced PTSD and depression, lessened negative attributions and facilitated posttraumatic growth in active-duty service members. The goal of Adaptive Disclosure is to create a safe space to challenge and revise harmful attributions so that forgiveness and reparation are possible. During therapy, the client receives support and input from the therapist, but also engages in an imagined dialogue with a forgiving moral authority. This highlights a parallel between post-traumatic growth and recovery from moral injury, as a supportive social environment is key in both processes.
Based on this evidence, we propose a tentative model (Figure 1) that integrates work on post-traumatic growth and moral injury in an attempt to stimulate further dialogue and research. To illustrate the concepts and pathways in the model, we consider the example of a service member who entered the armed forces believing he is a good person who can make a difference by serving his country. However, in a chaotic and dangerous situation during his deployment, he accidentally kills an innocent civilian. He believes that this act contradicts his personal morals. The ensuing sense of dissonance he experiences can be reconciled through one of two processes: assimilation or accommodation. He can assimilate his actions into his pre-existing beliefs, for instance by reminding himself of the reality of collateral damage in war and telling himself, "I had no choice. We didn't know if he was an enemy combatant, so it was him or me. I'm still a good person doing the right thing here." This may reduce his dissonance in the short term, although he remains vulnerable to moral injury in the future if his actions are judged negatively by others (e.g., public opposition to the war).
An alternative way to reconcile the dissonance is for him to change his prior beliefs.
Initially this is likely to take a maladaptive route, as he questions whether he really is a good person doing the right thing (e.g., "I can't go back home and pretend to be a good husband and father after I've murdered an innocent person"). In the absence of a supportive network, feelings of guilt and shame and beliefs about his immorality can become more entrenched, perhaps leading him to withdraw from others and continue a vicious cycle of self-blame, distress, and isolation. However, with the support of a clinician, partner or trusted comrade he may begin to disclose these feelings, accept responsibility for his past and learn that it does not have to define who he is or will be in the future (Gray et al., 2012). As outlined in Figure   1, the process of self-disclosure can facilitate self-forgiveness and the development of new flexible, adaptive beliefs (i.e., "positive accommodation"), which in turn may promote posttraumatic growth. At the end of this process, the demoralised solider in our earlier example, may report learning that everyone is capable of good and evil, but claim that from now on he will strive to do the most good he can in the world, regardless of what a particular situation might lead him to do.

Questions for Future Research:
Although there is reason to believe that people who commit violence can experience post-traumatic growth, there are still more questions than answers at this point. Here, we discuss some of the most important questions that future theoretical and empirical work will need to address.

(1) What Types of Violent or Morally Injurious Acts lead to Post-Traumatic Growth?
Although our examples have built on moral injury research and focused on violence perpetrated by military personnel, our proposed model is also intended to apply more broadly to non-military contexts. However, while the process might operate similarly, not all violent acts are viewed the same. The intentionality, severity, and perception of each act of violence will differ. This raises the question of whether the type, magnitude and severity of a violent act may limit possibilities for post-traumatic growth. Research into the relationship between lifetime trauma history and mental health has found an inverted U-shape curve, such that individuals who have experienced very low or very high levels of trauma are less resilient than individuals who have experienced a moderate level of trauma (Seery, 2011). It therefore seems plausible that there might be an upper severity limit for perpetration of violence, beyond which post-traumatic growth is unlikely to occur. Furthermore, other people are likely to be far less forgiving in response to certain acts of violence (e.g., genocide or child abuse) such that an individual's capacity for post-traumatic growth is more likely to be thwarted without a supportive environment (Joseph & Linley, 2005). Future research is needed to identify which characteristics of the act and person will hinder self-forgiveness and post-traumatic growth. For example, a propensity for shame, belief in a just world, selfesteem and cognitive flexibility have all been identified as traits that may influence recovery from moral injury (Litz et al., 2009).
(2) Dual Identities: Being Both a Perpetrator and a Victim of Violence: We have a tendency to view a person as either a perpetrator or a victim of violence.
However, in some instances, the distinction is not so clear-cut. For example, a gang member may have killed others, and have also been threatened, assaulted, and lost loved ones. In these complex cases, how do victimization and perpetration interact to produce (or block) growth?
The cognitive process may be similar to the one we have outlined in Figure 1, but additional considerations might make either assimilation or negative accommodation more likely. For example, research on post-conflict reconciliation indicates that an enduring sense of competitive victimhood between perpetrators and victims prevents forgiveness (Schnabel, Halabi & Noor, 2013). Thus, if perpetrators see themselves as victims but others disagree with this framing, then the social support needed to promote self-forgiveness, acceptance, and post-traumatic growth is lacking and an individual will tend towards assimilation (e.g., "I did what I had to do to survive") or negative accommodation ("I know how this feels and yet I did it to another. I am a bad person").

(3) What is Post-Traumatic Growth in this Context?
Researchers have assessed post-traumatic growth with various self-report inventories (Tedeschi & Calhoun, 2011), which have typically been validated with individuals who were victimized by violence, not those who committed it. It is worth questioning whether these scales are ideal for understanding growth in people who commit violent acts; different domains may be relevant or existing domains may be interpreted differently. For instance, a desire to make amends may enhance a person's sense of social responsibility leading to greater advocacy and service to others, but these cognitions and behaviours are not explicitly captured within most existing inventories.

Conclusions:
We have posed a controversial question: can people experience post-traumatic growth from committing acts of violence? We have answered yes, it is possible that some individuals who commit violence may experience post-traumatic growth. We have based this on the consistency of existing theoretical models and on the scant empirical work published to date.
However, many questions remain. Research is needed to understand the limits of this possibility and the types of violent acts that prevent the occurrence of post-traumatic growth.
It is our hope that this article will stimulate further discussion, research, and revision of our proposed model. In contributing to this discussion, our aim is not to condone violence, glorify it as a path to flourishing, or minimize the importance of research and practice focused on helping survivors of violent victimisation. Rather, it is our hope that this line of inquiry can complement existing research and provide insights into the similarities between the recovery processes of those who experience and those who commit violent acts.