Exploring posttraumatic growth: A systematic review of related factors in parents following preterm birth, and a grounded theory study of the role of psychological therapy in young adults following complex trauma

Fullick, Jade 2025. Exploring posttraumatic growth: A systematic review of related factors in parents following preterm birth, and a grounded theory study of the role of psychological therapy in young adults following complex trauma. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

This thesis explores how individuals make sense of and grow from traumatic experiences, as well as the role of psychological support in facilitating this growth. Across two distinct but connected papers, it focuses on populations whose voices are often underrepresented in trauma research: parents navigating preterm birth and young adults living with the impact of complex trauma. Although these two contexts differ, both are characterised by significant trauma and the potential for posttraumatic growth (PTG). Posttraumatic growth refers to positive psychological change that can emerge through the struggle with adversity. It may involve a deepened appreciation of life, improved relationships, personal strength, spiritual development, or the discovery of new possibilities. Growth does not mean that adversity is beneficial or desirable, nor does it diminish the real and lasting impact of distress. Instead, it acknowledges that people can find meaning in their experiences and move forward with a changed sense of self, others and the world. The first paper is a systematic review that synthesises current evidence on factors related to PTG in parents following preterm birth. Preterm birth, defined as childbirth before 37 weeks of gestation, is a global health challenge, affecting approximately 13.4 million babies annually. For parents, experiencing preterm birth can be profoundly distressing, characterised by uncertainty, separation from their baby, and the loss of imagined pregnancy and birth experiences. Historically, research in this area has focused almost exclusively on parents’ psychological distress, including depression, anxiety, and posttraumatic stress. While these outcomes are critical to understand, they offer only a partial picture of parental adjustment. Emerging research suggests that some parents also report growth, but until now, no review has explicitly examined the factors related to PTG in parents of preterm infants. The review included 13 studies representing over 2,500 parents across diverse cultural contexts. These studies examined a wide range of factors: demographic, psychological, social, and event-specific (such as gestational age). Across studies, PTG was most consistently linked with psychological factors such as deliberate rumination, emotional resilience, and coping strategies, as well as social support. Event characteristics, such as lower gestational age or longer hospital stays, were also associated with higher PTG. However, findings were mixed, and methodological variability made comparisons difficult. The review concluded that PTG in this context is shaped by a complex interplay between internal resources, social environments, and the subjective meaning assigned to events. Importantly, it highlighted the need for more inclusive, longitudinal, and coordinated research to increase understanding of PTG and guide psychological support for parents. The second paper continues the focus on PTG by exploring a different but equally underrepresented group: young adults with lived experience of complex trauma. Complex trauma refers to early and repeated traumatic experiences that happen in relationships. It can significantly affect identity development, emotional regulation, and the ability to trust others. However, many young people identify with PTG following complex trauma, possibly influenced by their subsequent engagement with therapy. This qualitative study used Constructivist Grounded Theory to explore how eight young adults (aged 18–25) experienced PTG and perceived psychological therapy to support this process. Therapy emerged as a relational space in which young adults developed selfunderstanding, processed trauma, and found agency. The resulting model identified five interlinked components: provisions for growth, a therapeutic foundation, therapeutic change, pathways to growth, and posttraumatic growth as an ongoing process. Participants described the importance of emotional safety, being genuinely heard, and a collaborative, non-pathologising therapeutic relationship. These relational experiences provided the scaffolding to explore difficult memories and reconstruct personal narratives, contributing to PTG alongside personal agency. Taken together, the two studies offer complementary perspectives on PTG: one through a structured analysis of quantitative findings across the literature, and one through the rich, first-person accounts of those with lived experience. They suggest that growth after trauma is not only possible but is often shaped by the relationships and systems that surround people, alongside individual characteristics and agency. From a theoretical perspective, the thesis contributes to a more nuanced and relational understanding of PTG. Clinically, it invites services to hold space for both distress and growth, and to design support that is sensitive to the lived realities of those it serves. For parents of preterm infants, this may mean integrating psychological support into neonatal care in ways that acknowledge the potential for growth without minimising trauma. For young adults recovering from complex trauma, it may mean offering therapy that is attuned, empowering, and co-created. Ultimately, this thesis is grounded in the belief that, even following adversity, people can reconnect with themselves, reimagine their futures, and grow in unexpected ways, especially when they are met with compassion, support, and understanding.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	28 July 2025
Last Modified:	28 Jul 2025 14:35
URI:	https://orca.cardiff.ac.uk/id/eprint/180061

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