Personal Recovery from Posttraumatic stress: The contribution of Self-Disclosure as a Personal and Interpersonal Characteristic of the Couple Relationship

Over the course of one’s life, many people will be exposed to different traumatic events. Approximately six to nine percent of the general population will, at some time, develop posttraumatic stress disorder (PTSD) (Goldstein et al., 2016; Kessler et al., 2005; Killikelly et al., 2019; Koenen et al., 2017). PTSD is characterized by arousal, panic reactions, nightmares and flashbacks, avoidance manifested in emotional numbing, negative changes in cognition and mood, guilt, etc. (Boulanger, 2008; Goldstein et al., 2016; Yehuda et al., 2015). Much research has been conducted regarding the clinical trajectory of the disorder and its symptoms, all in the context of considering PTSD as a chronic disorder (Caspi, 2016).

The present study wishes to present the recovery-based model, a model generally applied to recovery from serious mental illness, and to apply it to recovery from PTSD.  According to Anthony (1993), recovery is a subjective individual process defined by the individuals themselves, and in its essence bound up with leaning on support systems (Duff, 2016). Personal recovery itself is conceived of as an element within the presence of the illness (Davidson & Roe, 2007), and as a dynamic process involving changes to one's attitudes, values, aims, skills and/or roles (Anthony, 1993). The process creates a path for a meaningful life with satisfaction, hope, and meaning, despite the limitations caused by the illness and its symptoms (Leonhardt et al., 2017; Slade et al., 2012). The current study is based on the conceptualization of the recovery-based model, and emphasizes self-confidence and hope, non-dominance of symptoms, the personal capacity to ask for help, and reliance on others.

The social context emphasized in the recovery-based model is also a main feature in ecological references regarding the definition of the development and ability to cope with PTSD (Harvey, 1996; Maercker & Horn, 2013). According to these references, social and interpersonal contexts are meaningful in understanding variances in individual responses to traumatic events, and how people cope with these differently. Accordingly, and based on the assumption that a romantic partner is an adult’s main social support resource (Doherty & Feeney, 2004), the current study engaged with couple relationships and with couple-related variables: the participant’s self-disclosure, the partner’s response, and the contribution of these variables to recovery. Self-disclosure, and specifically the self-disclosure of traumatic events, has been found to be related to mental well-being and to reducing PTSD levels (Bolton et al., 2003; Grice et al., 2017; Köhler et al., 2018). It has therefore been examined as a personal characteristic, and in the current study as an interpersonal characteristic of the couple relationship as well.

The purpose of the present study was to examine the connection between the characteristics of the traumatic event and subsequent recovery. Specifically, the study analyzed the contribution of self-disclosure, as both a personal characteristic and as an interpersonal characteristic of the couple relationship. The study focused on the effect of the self-disclosure of traumatic experiences within a couple relationship with regard to promoting personal recovery. The level of PTSD was examined as a variable moderating the positive connection between self-disclosure and recovery. Additionally, the partner’s response was considered as a variable mediating the connection between self-disclosure (within the couple relationship) and recovery, based on the assumption that the existence of this connection would be related to the partner’s perceived response to the disclosure.

Methods: After receiving the approval from the Ethics committee, data collection was conducted through a computerized questionnaire, distributed online via different social media platforms. The study population consisted of 180 participants: 98 women and 82 men, aged 21-71, who had been  exposed to at least one traumatic event over the course of their lives. The most common traumatic events reported by the study participants were the death of a loved one, war, and sexual assault. The following variables were examined: recovery (Recovery Assessment Scale - RAS; Giffort et al., 1995); self-disclosure as a personal characteristic (Self-Disclosure Index - SD; Miller et al., 1983); self-disclosure of traumatic experiences within the couple relationship (Combat Disclosure Scale - CDS; Balderrama-Durbin et al, 2013(; and partner’s response to the disclosure (Partner Response to Disclosure; Allen & Renshaw, 2005).

Results: Regarding the research hypotheses concerning the characteristics of the traumatic event, a curvilinear correlation was identified between the number of traumatic events and recovery. Contrary to the research hypothesis, no differences were found between the type of traumatic event type and differing levels of recovery. In line with the research hypotheses, the current research found that people with a higher tendency for self-disclosure reported achieving higher levels of recovery, and that the more they disclosed within their relationship the higher their perceived recovery. Contrary to the research hypothesis, PTSD level was not found to moderate the correlation between self-disclosure and recovery. However, the current study did find that PTSD level mediated the correlation between self-disclosure in the couple relationship and personal recovery. In line with the research hypothesis, a partner’s response to the participant’s self-disclosure mediated the correlation between self-disclosure of traumatic events within the couple’s relationship and recovery.

Conclusions: The study's results support the theoretical framework proposing the social context as  a key element in recovery from trauma ( Harvey, 2007; Maercker & Horn, 2013), strengthening the importance of defining recovery as a subjective individual process— in accordance with the recovery-based model (Duff, 2016; Silverstein & Bellack, 2008).

Limitations of the study: The data used in this study were based on participants’ subjective reports and as such may be biased and incomplete, especially so given that the questionnaire dealt with sensitive trauma-related content. Furthermore, the questionnaire was distributed online, potentially circumscribing participant variety and precluding the participation of people who do not use social media. Moreover, the generalizability of the findings to the general population is limited, insofar as people who agreed to participate in the study may already tend more towards higher self-disclosure than people who chose not to participate. This potential bias must be taken into account.

Importance of this research: The importance of the current research lies in its promotion of the recovery-based model in supporting recovery from PTSD, presenting it as a way to help sufferers regain confidence and meaning in life in the wake of a traumatic experience. The results of the research point clearly to the importance of an ecological perspective regarding trauma, and are consistent with ecological paradigms for understanding trauma (Harvey, 1996, 2007; Maercker & Horn, 2013). In practical terms, the research has implications for couple therapists treating couples coping with PTSD, in terms of promoting self-disclosure within the couple’s relationship. Furthermore, the current study is one of the first to deal with exposure to a variety of traumatic events and relating to a partner’s perceived response to the patient’s self-disclosure. The knowledge gained here in terms of self-disclosure within the couple relationship, and couple support in the aftermath of such disclosure, will be useful in promoting PTSD recovery processes (Dworkin et al., 2019).