Post-traumatic growth in schizophrenia and alcohol addiction

Introduction: The purpose of this paper is to look at the relationship of post-traumatic growth with both type and intensity of trauma in two clinical groups: schizophrenia patients and alcohol-addicted individuals who have had various experiences of a traumatic nature. Material and methods: The subject matter is an analysis of how personal variables (personality traits, self-efficacy, character strengths) can influence the post-traumatic growth in the samples. The study verifies also what events were perceived by the patients as traumatic and life-changing, as well as what differences could be observed in the level of post-traumatic growth in the samples. The goal of the analysis is to find which group has recorded a higher level of post-traumatic growth overall and on specific subscales. Results: The obtained results show that the analysed groups differ in the levels of post-traumatic growth; the highest level was observed among the alcohol-addicted individuals in the scope of their changed perception of self. Post-traumatic growth can be linked, above all, to such personality traits as extraversion and prudence, but only in the group of alcohol-addicted individuals. The largest number of links was found between post-traumatic growth and character strengths, and in this case the quality and quantity of these links were attributed mostly to the group of addicted persons. Conclusions: Further research and advancement of the knowledge would be necessary in order to make post-traumatic growth in mentally-ill persons a milestone of their recovery; moreover, further studies would be helpful for the adaptation of psychological interventions aimed at achieving post-traumatic growth.

Curr Probl Psychiatry, Vol. 25 (2024) Słowa kluczowe: schizofrenia, uzależnienia od alkoholu, rozwój potraumatyczny Mental illness may be a traumatic experience having long-term consequences for the functioning and the quality of life, and these consequences may include loneliness and inability to work.The most frequently-presented analyses focus on the identification of mechanisms contributing to escalation and very development of mental disorders.However, it has been noted in parallel that persons with mental illness report also positive changes resulting from the difficult and traumatic experiences of mental disorders.The aforementioned changes may include such mental processes as self-discovery, development of sense of self, greater appreciation of life, improved well-being, improved relationships with others, spiritual engagement.[1,2] The most established model describing the positive change that follows the trauma of mental illness is the post-traumatic growth model defined as the positive psychological transformation which can result from a highly emotional fight with traumatic or stressful encounters.The psychological phenomenon known as post-traumatic growth has been described as the transformation occurring in at least five areas: increased appreciation of life, search for more meaningful relationships, feeling of personal strength, identifying new life priorities, spiritual enrichment and including existential matters in one's philosophy of life.[3] Post-traumatic growth may occur even from the very onset of the illness and in such a case it typically remains on a moderate level.Moderate post-traumatic growth may relate to the following areas: intrapersonal (sense of self), interpersonal (improvement of relationships), spiritual [4].Experiencing positive changes during such time is related to the extent of working with health-care professionals and the effectiveness of such work.[5] In the cross section it can be found that post-traumatic growth may be linked to both positive and negative consequences for patients who have experienced mental illness.Positive changes can relate to: increased meaning of life, positive reformulation of own experience, will to connect with others, self-discovery (discovery of true and personal needs), dealing with self-efficacy, spiritual dealing with important existential questions, perception of social support.Even very difficult experiences, such as hospitalization due to mental illness, can be perceived in a positive manner.The level of mental resilience also increases; the basic personal beliefs change, and so does the recovery.These changes can also have a dark, negative side, which is related to such factors as: time elapsed since the beginning of illness (the shorter, the more frequently it can be seen as negative influence), history of failures and traumas triggered by that event, existential burden of age, uselessness of education obtained before the illness, growing awareness of the inability to practice a profession, feeling of inability to meet parenting challenges.In short, in early stages of the illness the patients may face a range of difficult situations which make it harder to have a positive outlook on events surrounding the experience of illness.
In connection with the literature on the subject, the links of post-traumatic growth with the type and intensity of trauma have been looked at in this paper.The differences found between the selected clinical groups have also been examined in this scope.The paper is aimed at determining which personal variables are linked to post-traumatic growth in persons suffering from schizophrenia and addiction.[6] 1. Research methodology

Sample statistics
The study analysed the results obtained from two clinical groups who received the diagnosis of alcohol addiction and schizophrenia.Each sample consisted of 30 persons; 60 persons receiving outpatient medical care were examined.The participants took part in a single examination of the selected variables.
Inclusion criteria: patients with diagnosed schizophrenia or alcohol addiction, research criteria ICD-10), age of 18-65 years, voluntary and informed consent to the participation in the study, no active alcohol or psychoactive substance dependence.
Exclusion criteria: acute psychotic disorders making the participation in the study impossible (disorders scoring higher than moderate severity at the BPRS), active alcohol or psychoactive substance dependence.
The group of schizophrenia patients consisted of 14 females and 16 males, while the composition of the alcohol-addicted group was as follows: 5 females and 25 males.The average age in both groups was 43 years.In the examined sample, more unemployed persons were found among the schizophrenia patients (24 people).Similar proportions were recorded in the two groups in terms of receiving a pension.Few addiction patients were pensioners (2 persons).The longest duration of illness was noted among schizophrenia patients (18 years).In the samples, single people were found mostly in the schizophrenia patients' group (26 persons).The group of addicted individuals had a smaller number of single people (15 persons said they were in a relationship).

Research tools and procedure
The Senate Committee on Research Ethics has consented (no.19/2021) to the implementation of this research.Each patient was examined once.The participants were receiving outpatient treatment at the time of the study.
The following tools were used in the research:  1998) -questionnaire to identify five basic personality factors: neuroticism, extraversion, openness, conscientiousness and agreeableness. 5. General Self-Efficacy Scale (GSES, adapted by: Juszyński, 2000) [8] -it measures the individual's power of general self-efficacy in coping with difficult situations and obstacles 6. Post-Traumatic Growth Inventory (PTGI, adapted by: Ogińska-Bulik; Juczyński, 2010) [9].It is used for measuring the overall level of post-traumatic growth.The obtained results are described using four factors and one overall result.The first factor covers the changes in perception of self; the second one concerns the changes in relationships with other people and covers the development of more intimate connections, such as those of altruism and empathy.The third factor concerns greater appreciation of life, changes in life priorities and philosophy.The last one concerns spiritual changes, which are understood as a better understanding of issues of spiritual nature and life philosophy.The overall result is the sum of all factors.The higher the result, the more positive changes done as a consequence of the experienced trauma.The results of the study were analysed statistically using the IBM SPSS Statistics -24 software.The relationships between the variables were assessed using the r-Pearson correlation.The differences between the compared mean values were analysed using the t-Student statistics.The Cohen's d coefficient was used to measure the effect size between the means.The p</= 0.05 level of significance was assumed for the analysis.

Purpose
The aim of the article is to present a clinical case of a 27-year-old patient, previously untreated psychiatrically, with a recent The purpose of the study is an attempt to determine the significance of type and intensity of a traumatic event for post-traumatic growth in mentally-ill individuals.The study aims to verify which personality factors (personality traits, self-efficacy, character strengths) are correlated with post-traumatic growth in mentallyill individuals who have experienced various traumatic events.Another objective of the study is to determine the level of post-traumatic growth in specific groups and to establish which group showed a higher level of posttraumatic growth.

Differences in samples in terms of the tested variables
At first, the results obtained were analysed on the basis of mean values observed for each of the samples.The analysed variables were concerning: personality, self-efficacy, character strengths, post-traumatic growth.The below tables present only the statistically significant results.
Table 1 presents the results which describe the differences between schizophrenia patients and addicted individuals in the scope of developing post-traumatic growth.
The above analyses present one result differentiating the compared groups on a statistically significant level, that result being the perception of self.The observed difference was on a medium level.The addicted individuals perceived themselves considerably better than the schizophrenia patients.2 presents the results which describe the personality differences between the schizophrenia patients and addicted individuals.
The results obtained show that, in the scope of the variables analysed, the schizophrenia patients differ from the alcohol-addicted patients in one of the personality dimensions, being extraversion.The addicted individuals have shown a significantly greater presence of that personality trait than the group of schizophrenia patients.Table 3 presents the differences between the schizophrenia patients and addicted individuals in the scope of character strengths.
The above analyses present two variables differentiating the compared groups on a statistically significant level in the scope of character strengths, these variables being the love of learning and bravery.Both variables differentiated the groups on a medium level.
No statistically significant differences were found between the samples in the scope of self-efficacy.

Correlations
A correlation analysis was performed in order to determine the relationships between the examined variables.
Statistical analyses describing the links between particular personality traits and post-traumatic growth factors are presented below.The correlations were conducted in all samples.It should be noted that no statistically significant relationships were found in this study between personality and post-traumatic growth in the schizophrenia patients.The details are presented in the tables below.
The conducted analyses show statistically significant relationships between the following variables measured in the group of addicted individuals: extraversionincreased overall post-traumatic growth, perception of self, interpersonal relationships.The relationships between prudence and greater appreciation of life were similar.
Statistical analyses describing the relationships between the subscales of post-traumatic growth and character strengths are presented below.The correlations were conducted in all samples.The details are presented in the tables below.Table 5 presents statistically significant links observed between the analysed variables in the sample of schizophrenia patients.In the case of the schizophrenia patients, the conducted analyses show statistically significant results in the level of changes in perception of self and such character strengths as fairness and appreciation of beauty.
Table 6 presents statistically significant relationships between the subscales of post-traumatic growth and character strengths in the group of addicted individuals.
In the results pertaining to the group of addicted persons, statistically significant results were found in the level of change in the overall growth versus the subscales of character strengths including optimism, spirituality, zest, fairness, self-regulation, humility, appreciation of beauty, honesty, perseverance, gratitude and forgiveness.In the case of perception of self, statistically significant relationships were recorded with such character strengths as optimism, spirituality, self-regulation, humility, appreciation of beauty, perseverance and gratitude.The level of interpersonal relationships had a statistically significant link with such variables as fairness, humility, appreciation of beauty, gratitude, forgiveness and kindness.The third factor of post-traumatic growth, being the appreciation of life, was linked to such character strengths as optimism, spirituality, zest, humility, honesty, perseverance, gratitude and leadership.Spirituality had a statistically significant correlation with spiritual change and gratitude.
It should be noted that the group of addicted persons showed a statistically higher correlation between selfefficacy and greater appreciation of life, which is the third factor in post-traumatic growth (r=0.431,p= 0.025).At the same time, the group of schizophrenia patients showed no statistically significant relationship between self-efficacy and post-traumatic growth and its factors.

Life-changing (traumatic) event
For the analysis of post-traumatic growth in the samples, the data pertaining to the type of traumatic events most frequently experienced by the participants as well as the time that has elapsed since such event have been presented.Details in Table 7.The traumatic events which have been indicated the most frequently in the analyses presented above were chronic or acute illness and loss of a loved one.The results in this scope were almost unanimous.

Discussion
The participants were persons who, having decided to undergo treatment, had to go down the difficult and often traumatic road to insights, which can happen in both schizophrenia patients and addicted individuals receiving outpatient treatment.The insight into an illness is a difficult experience which comes at a cost of effort and often the necessity to question the fundaments of human existence, such as believing own judgement and taking responsibility for own decisions [10].The development of insight can decrease the quality of life due to the negative relationship with the hope for therapeutic success.The most important therapeutic goal in such situation would be to separate the illness from the image of self.Such attempt could give the patient hope and also help them treat the insight as a useful tool in the process of combating the struggles of mental illness.Being hopeful is another one of the most important factors contributing to post-traumatic growth.[11] The aim of this study was to investigate the relationship of the type and intensity of trauma with posttraumatic growth in two clinical groups: schizophrenia patients and alcohol-addicted individuals.According to research, chronic illness is an example of a traumatic event [12].The study aimed at analysing which personality factors (personality traits, self-efficacy, character strengths) could be relevant for post-traumatic growth in the samples.The study verifies also what events were perceived by the patients as traumatic and life-changing, as well as what differences could be observed in the level of post-traumatic growth in the samples.Additionally, it was examined which group showed a higher level of posttraumatic growth overall and on specific subscales.
The comparison of mean values of particular variables between the groups revealed several statistically significant differences between them.The participants of the two groups differed in one of the factors of post-traumatic growth, and that factor was the changed perception of self.As a result of traumatic events the alcohol-addicted individuals saw more positive changes in their perception of themselves than the schizophrenia patients did.The samples did not show any significant differences in the other parameters of posttraumatic growth, being the overall growth level, changed interpersonal relationships, greater appreciation of life and spiritual changes.These differences could potentially indicate that the two groups differ considerably from each other in terms of the ability to change as a result of posttraumatic growth.
The analysis of the results relating to personality traits indicates that the persons addicted to alcohol showed a much higher level of extraversion than the schizophrenia patients.The differences between the mean levels of neuroticism, openness, conscientiousness and agreeableness were not found to be statistically significant.High level of extraversion favours frequent experiencing of positive emotions, being active and engaging in interpersonal activities and relationships.It is precisely the latter consequence that could be the personality characteristic favouring the search for social support on any level, and above all, on the most valued level, which is emotional support.Of course, emotional support, as much as any kind of help, should have some specific features, e.g., it should be adapted to the recipient's needs and capabilities [13,14].Extraversion, in turn, can be linked to a great need for stimulation and a high level of energy [15].This trait can, therefore, have a positive influence on the post-traumatic growth, as shown by the conducted correlation analyses.It has been observed in the group of alcohol-addicted individuals that the level of extraversion had a positive correlation with overall post-traumatic growth, changed perception of self and changed interpersonal relationships.The relationship between prudence and greater appreciation of life was similar.The correlations between these variables were not found to be statistically significant in the group of schizophrenia patients.
The personality resources which were found Curr Probl Psychiatry, Vol. 25 (2024) to support the process of positive changes include: spirituality, life optimism, hope, self-esteem, self-efficacy and resilience.In terms of character strengths, the study found statistically significant differences in the mean values of two of them: love of learning and bravery.Higher mean values of both of these character strengths were recorded among the individuals addicted to alcohol.The other differences between the mean values of particular character strengths had no statistical significance.The analysis of correlations between character strengths and post-traumatic growth showed several statistically significant relationships in the samples.In the group of addicted individuals there was a positive correlation between overall post-traumatic growth and such character strengths as: spirituality, optimism, zest, fairness, selfregulation, humility, appreciation of beauty, honesty, perseverance, gratitude and forgiveness.In the case of perception of self, statistically significant relationships were recorded with such character strengths as optimism, spirituality, self-regulation, humility, appreciation of beauty, perseverance and gratitude.The level of interpersonal relationships had a statistically significant link with such variables as fairness, humility, appreciation of beauty, gratitude, forgiveness and kindness.The third factor contributing to post-traumatic growth -greater appreciation of life -was linked to such character strength as optimism, spirituality, zest, humility, honesty, perseverance, gratitude and leadership.Spiritual development, being one of the factors contributing to post-traumatic growth, was linked to spirituality and gratitude [16].In the group of schizophrenia patients, statistically significant relationships were noted between one of the factors contributing to post-traumatic growth (changed perception of self) and two character strengths (fairness and appreciation of beauty).In the case of addicted persons, another statistically significant result was noted, and it was the correlation between selfefficacy and appreciation of life.The character strengths of an individual could act in favour of post-traumatic growth both directly and indirectly, by determining more effective and adapted methods of coping with traumatic events [17].
The traumatic event that was indicated the most frequently by both groups was the experience of chronic or acute illness, and the time elapsed since that event was usually longer than five years.The time of more than five years was not always attributed to the illness as the traumatic event.In addition, the participants perceived various experiences as life-changing, not only the experience of illness.It could mean that the patients do not always see an illness as a traumatic event because in the course of life they get to experience other events which could also be perceived as traumatic, which is also the case among healthy individuals.It should be noted, at the same time, that there is a chance that patients may create positive reformulations of their life situation where the illness can, over time, gain a new non-traumatic meaning.This case has been described in the literature on the subject, where throughout the course of the mental illness the patients slowly come to offset the emotional significance of the disease by slowly increasing the disproportion towards the positive assessment.[18,19] The quoted research studies point out the issue of post-traumatic growth in mentally-ill individuals, which, as a process, has not been investigated in depth and requires further exploration.The use of measurements originating from positive psychology (such as character strengths) in relation to that population is not as frequent as questionnaires evaluating various deficits.
Thus, the search for determinants of post-traumatic growth in mentally-ill individuals might cover also other variables, such as hope, optimism, gratitude or resilience, which have been found to be significant for post-traumatic growth in the healthy population.Further research and advancement of the knowledge would be necessary in order to make post-traumatic growth in mentallyill persons a milestone of their recovery; moreover, further studies would be helpful for the adaptation of psychological interventions aimed at achieving posttraumatic growth.

Conclusions
The participants in the study were patients with two different clinical diagnoses, and those were schizophrenia and alcohol addiction.The obtained results indicate that: 1.The analysed groups differ from each other in terms of level of post-traumatic growth, where the group of alcohol-addicted individuals showed a considerably greater change in perception of self.2. Post-traumatic growth can be linked mostly to such personality traits as extraversion and prudence, but only in the group of alcohol-addicted individuals.3. The largest number of relationships was found between the post-traumatic growth and character strengths; in this case, the quantity and quality of these relationships was attributed mostly the alcohol-addicted individuals.

Table 1 .
Post-traumatic growth -mean values and differences between them in the schizophrenia and addiction groups.N=60.

Table 2 .
Personality -mean values and differences between them in the schizophrenia and addiction groups.N=60.

Table 3 .
Character strengths -mean values and differences between them in the schizophrenia and addiction groups.N=60.

Table 6 .
Relationships between the subscales of post-traumatic growth and character strengths in the group of addicted individuals.N=30 Curr Probl Psychiatry, Vol.25(2024)

Table 7 .
Life-changing events -frequencies and time elapsed since trauma