Mental health Patient stories Rehab Sunnybrook Magazine – Spring 2017

The phenomenon of post-traumatic growth

Nazreth LIbab

Nazreth Libab experienced post-traumatic growth after a near-death bus crash. “I couldn’t help but feel how fortunate and how blessed I was,” she says. “The more I paid attention to those positive things, the more I could be at peace with my situation.” (Photograph by Kevin Van Paassen)

Recovering from a horrific collision, Nazreth Libab had plenty of reasons to sink into the depths of despair.

She was on a bus travelling in rural Ghana when it blew a tire and careened off the road. She sustained life-threatening injuries that included nearly two dozen fractures and a serious risk of paralysis.

As she recovered, Nazreth experienced excruciating pain as well as intense feelings of fear, distress, frustration and anger.

“There was every negative human emotion imaginable,” recalls Nazreth, 32, whose job in international development had taken her to the West African nation last spring.

Following the bus crash, which occurred in a village three hours away from the capital city of Accra, she was cared for at three hospitals across two continents, before returning to Canada, and then received treatment at Sunnybrook’s St. John’s Rehab.

Throughout the whole ordeal, Nazreth came to realize that the collision had broken her body, but not her spirit. Indeed she felt “blessed to be alive,” experiencing a phenomenon known as post-traumatic growth.

“There was a moment of clarity and a new world opened up. It changed my outlook on life,” Nazreth says. “I couldn’t help but feel how fortunate and how blessed I was. The more I paid attention to those positive things, the more I could be at peace with my situation.”

According to Dr. Paula Gardner, a clinical psychologist at St. John’s Rehab, post-traumatic growth – which she describes as “a positive change or transformation following the struggle of a major life crisis” – is increasingly being researched.

Post-traumatic growth appears to affect about half of all trauma survivors, Dr. Gardner notes. The contributing factors include whether the traumatic event opens up new opportunities, makes relationships more meaningful, helps a person tap into inner strength, triggers new perspectives on what really matters and brings about a deepening of spirituality or faith.

“Some people can’t even conceive of anything positive coming out of what’s happened to them, but others feel there are ways to find meaning and live a quality life, even given their losses and limitations,” says Dr. Gardner, pointing out that it’s critical to have a support system, which can involve family, friends, medical therapists and spiritual guidance.

Dr. Matthew Boyle, a psychiatrist at Sunnybrook who treats patients in rehab care, reports that the general tendency after a life-threatening experience for most people is resiliency. “Because a trauma is such a significant event, it gives people an opportunity to re-evaluate their life, to experience interpersonal growth.”

He also notes the importance of identifying which recovering patients are struggling with mental-health difficulties following a trauma, as they can often benefit from increased supports such as psychotherapy, social support, and, sometimes, medications.

Sunnybrook is starting to offer peer support from others with lived experience, such as those who have survived strokes themselves and can help stroke patients and their families understand the challenges and triumphs ahead on their road to recovery.

Dr. Ed Hanada, a physiatrist who specializes in trauma rehab, monitors the progress of patients’ mobility and their ability to regain their functional independence.

People come to realize, he says, that “in an instant, their lives and those around them are shattered, metaphorically as well as physically.”

Those who have gone through adversity also realize, he adds, that “life means more to them” and they can often then achieve a higher level of functioning.

The rehab team at Sunnybrook helps patients who have lived through a traumatic experience to see that their journey can be “transformational,” making them stronger, he says. “Everyone has an important role in trying to instil that in the patient; it’s really a team effort.”

For her part, Nazreth was especially affected by the kindness of strangers and the help she received from friends and family, as well as the support of the wide range of rehab specialists at Sunnybrook who, she says, were “emotionally available” to her and became “cheerleaders” for even the smallest of her accomplishments.

“The first time I was able to put weight on my legs, it was like I had won at the Olympics,” she remembers, noting that Sunnybrook cultivates a positive environment. “You really feel like you have a community that is rooting for you, that truly thinks you’re going to get better. That kind of support is a lifeline. It helps set the stage for what you envision for yourself, and then you start to believe it.”

Nazreth says that it’s normal to revert to “extreme negativity” following a loss or catastrophe, but that can be overcome. “I was physically, emotionally and mentally causing myself more trauma through the thoughts I entertained. I remember being hooked to blood pressure machines and heart monitors that showed me in real time how the thoughts in my mind manifested in my physical body.”

“When a negative thought had my attention, I could see quite literally that my body was in crisis mode. That insight is something I will carry with me forever. We may not be hooked to machines in everyday life, but we can certainly remember that we play the key role in our well-being.”

She continues to get stronger and remains vigilant not to let negative thoughts return. “Allow yourself to go through the emotions of what you’ve been through, but don’t dwell [on them]. Feel it, then move forward,” she advises.

“We are so much more powerful than we give ourselves credit for. Nothing is impossible,” Nazreth says. “Life is miraculous and we forget that.

“I don’t ever want to lose sight of that again.”

Greater psychiatric support for patients in rehab

In-patients at Sunnybrook’s St. John’s Rehab can now benefit from more mental-health support services.

Dr. Matthew Boyle, psychiatrist, Hurvitz Brain Sciences Program, has recently begun collaborating with the specialized rehab teams at St. John’s Rehab to provide both psychiatry consultations and follow-up care.

Patients in rehabilitation, says Dr. Boyle, may experience mental-health conditions such as depression, adjustment disorder, anxiety, dementia and delirium.

Dr. Boyle works directly with the multidisciplinary in-patient teams to provide collaborative psychiatric care. He also helps to enhance the teams’ skills in engaging patients from a mental-health perspective.

“This collaborative model allows us to consult with the patient more effectively,” says Dr. Larry Robinson, chief, St. John’s Rehab Program. “Length of stay in rehab tends to be a bit longer. Dr. Boyle and our teams can get to know and gain a better understanding of the patient. This helps provide more holistic care for the patient in an integrated way.”