Research on Stress-Related Growth: Current Status and Future Directions

1. Research on Stress-Related Growth: Current Status and Future Directions Crystal L. Park University of Connecticut

2. A new emphasis on an old idea Over the millennia, many religious and philosophical systems have promoted the idea that through suffering can come transformation Even within psychology, these ideas have a long history. 1960s, Caplan�s crisis theory 1980s, resilience

3. New Emphasis Interest in positive psychology In the 1990s, research assessing positive life changes burgeoned. In fact, this phenomenon, which is known by a number of names (e.g., stress-related growth, adversarial growth, posttraumatic growth, benefit-finding) has been the subject of well over 100 empirical studies in just the past ten years.

4. Basics on Growth High levels of self-reported growth have been documented in samples of people dealing with disparate events combat cancer relationship dissolution bereavement sexual assault automobile accidents terrorist attacks

5. �I have become more tolerant, more sympathetic towards the disadvantaged� �In a way I have become more independent, better able to rely on myself� �I am so much more aware of life�s fragility, the need to grab each day and enjoy every moment� �I have refocused my energies on what is truly important to me, and learned to let the rest go� �My wife and I are much closer than we were before; we have learned to take care of each other� �I have become a much better listener� �I feel closer to God, and know now that He would never let me down� �I am much stronger than I ever imagined I could be�

6. Domains of Growth Coping skills and strength Interpersonal relationships Life philosophy/Wisdom Spirituality and religiousness Appreciation for life Lifestyle behaviors

7. Plan for Today�s Talk Describe the meanings of the phenomenon of growth Review prominent theories regarding the development and meaning of growth for individuals reporting them. Discuss three cutting edges issues measurement implications for individuals� well-being clinical and therapeutic applications

8. Meaning of Stress-Related Growth Conceptual definition Veridical changes that people have made in relation to their experience with an identified stressful or traumatic event. Typically occur in the domains of Personal relationships Coping skills New life philosophies Spiritual development Wisdom and maturity Compassion Lifestyle change

9. Meaning of Stress-Related Growth Operational definition a number of measures of positive life changes or growth have been developed. Researchers usually assess positive life changes or growth through self-report instruments, or less frequently, through coding of open-ended questions or interviews Virtually all research on this topic, therefore, has been based on self-perceptions of change, which may or may not correspond to veridical change.

10. Disconnect between conceptual and operational definitions Very little research has attended to the issue of demonstrating instrument validity (i.e., the correspondence of scores on a measure and actual real-life change) correlations between self- and informant-reports correspondence between growth as reported on a questionnaire with that reported in a writing sample

11. What do scores on self-reported growth instruments signify? Without strong evidence of validity, these reports do not necessarily indicate growth, but rather people�s perceptions of their growth.

12. What do scores on self-reported growth instruments signify? Because such reports involve individuals� own perceptions, there are several different perspectives regarding their meaning. One is that the perception of positive change, regardless of any veridical change, is an important phenomenon in its own right. But many researchers and clinicians have an explicit interest in the occurrence of true (i.e., reflected in external reality) positive change that can result after crisis

13. Constructs reflected in self-report measures of growth

14. Theories: How does (veridical) growth occur? General theory of MEANING MAKING

16. What is meaning making? Attempts to assimilate the experience of cancer into one�s meaning system (beliefs and goals) by changing the meaning of the cancer or accommodating the cancer by changing one�s global meaning system Can be effortful (meaning making coping, searching for meaning) or unconscious attempts at integration (e.g., intrusions and avoidance symptomatology)

17. Theories: How does growth occur? General theory of MEANING MAKING Some pathways may not involve shattered assumptions, etc. Hot or cold cognition theories Cognitive Adaptation Theory (Taylor) Implicit theories of change (Ross)

18. Currently, there so great interest in growth in the context of medical illness and health conditions Medical illnesses often bring a great deal of uncertainty, fear, suffering, and loss Many of those who have encountered very serious illnesses have reported growth, both to researchers and in public forums. A function of modern US society-- very media-driven and health-focused culture as well as the long tradition of optimism and efforts at self improvement

19. Positive Life Changes in Young Cancer SurvivorsCrystal L. Park (PI) & Thomas O. Blank 250 younger adult cancer survivors, age = 18-50 (X = 45.2). Mean age at diagnosis was 42.8. 68% women 87% White, 4% African-American, 2% Asian, 5% Hispanic and 2% Native American. 94% had completed their primary treatment (mean time since treatment had ended = 1.6 years ago). In conjunction with the Cancer Registry, Hartford Hospital, Hartford, CT 167 participants at Time 2, one year later

20. Predictors of meaning and positive life changes and relations with meaning making and quality of life Description of positive changes Model of meaning making, meanings made, and psychological well-being

21. Some positive changes reported by survivors

25. Positive growth following cancer is an outcome of the meaning-making process: Identifying or creating positive aspects is one (adaptive) way to make meaning (reduce the discrepancy between global meaning and appraised meaning of the cancer)

26. Meaning making, Growth and other aspects of meaning, and Psychological well-being

29. Cutting Edge Issues Measurement Issues The meaning of stress-related growth in terms of subsequent health or psychological well-being Implications for interventions in health populations

30. Cutting Edge Issue 1: Measurement Many instruments currently available: Post-Traumatic Growth Inventory (PTGI) Stress-Related Growth Scale (SRGS) Benefit-Finding Scale (BFS) Change in Outlook Questionnaire (CiOQ)

31. Current Measures All essentially ask participants to report on whether they have made changes in a number of domains. Items are summed, and scores are considered to indicate the extent of growth. Many drawbacks limited domains response biases lack of opportunities to report change bidirectionally

32. Trends in Measurement of Growth Different directions being advocated: One proposes that the critical datum regarding perceptions of positive change is simply whether or not growth is perceived Alternate direction proposes moving towards increasingly complex measurement schemes, including refinement of items and scoring Another proposes getting away from self-report altogether and using objective indices Tennen and Affleck�s proposal-prospective

33. Cutting Edge Issue 2 The meaning of positive life changes and growth following stressful encounters

34. The meaning of growth following illness Examine the extent to which perceptions of growth are related to aspects of psychological and physical well-being

35. Relations between growth following trauma and well-being Results are inconsistent Studies generally suggest that perceived growth is: weakly related or unrelated to psychological distress weakly related or unrelated to well-being, such as positive affect and life satisfaction somewhat more consistently related to measures of objective and subjective physical health, esp. those specific to the disease

36. Explanation of inconsistencies in findings regarding links between growth and well-being Cross-sectional vs. longitudinal designs Possibility of non-linear relationships Important moderators Personality Demographics Distinguishing �real� growth from coping

37. Cutting Edge Issue 3: Issues Regarding Clinical Applications of Growth Intriguing questions regarding applications: Should we foster perceptions of positive life changes? Can we encourage these perceptions directly? Are there downsides to attempts at facilitating growth?

38. 10 Principles for Being an Expert Companion (from Tedeschi & Calhoun, in press) Acknowledge the difficulty of the situation. To the extent possible, be there through the difficulties. Be willing to listen to the hard parts of the story. Relate to the patient through his or her world view. Accept apparent �illusions� as useful to the patient. Help the patient manage anxiety and other emotions. Help the patient move from brooding rumination to more constructive reflection. Notice and remark about the strengths and changes that come from the struggle. Do not offer platitudes. Listen in a way that allows you to be changed.

39. Many Questions Remain Is growth a unitary phenomenon? Or should we speak of different types of positive changes? Does a change need to be permanent to count as �growth�? How closely tied to the stressful experience in question does a positive change need to be to be considered a result of the crisis? Do people need to be aware of the positive change and its source in order for us (or for them) to consider it �growth�? How do different dimensions of illness affect both the experiencing of positive life changes and the meanings of those experienced changes in the lives of those affected?

40. How does growth come about? What is the role of cognitive processes such as intentionally searching for or reminding one�s self about positive change? Is growth that results from a single traumatic event (such as rape) different from an ongoing long-term stressor such as daily medical regimens? What is the trajectory of growth? Is there a critical period for the initial development of growth? Does this period vary by the type and nature of the traumatic event (single event vs. ongoing stressor)?

41. These questions can be better answered with a new generation of more thoughtful and sophisticated conceptualizations and methodologies prospective designs experimental approaches observational studies behavioral assessments developmental studies

42. Conclusions Two notes of caution: Just because someone says that they have grown doesn�t necessarily mean that they have Important to view growth in the context of individuals� suffering and struggle Opportunity to understand more about the complex and resilient nature of human beings, including the mix of pain and struggle and recovery and transformation that characterizes most of our lives.

43. God�s Timing When the lip is cut, no matter how, the need to heal makes us chew slower, and drink to one side. It makes us speak only when we have something to say. These are not bad things. When the mind is cut, by a truth too sharp to hold, it makes us bleed the things we cling to. If lucky, we bleed the things that no longer work. When the self others have sealed us in is cut, it lets us escape with only what we were given at birth.

44. While there are terrible ways to be opened, there is no such thing as a bad opening. It�s all about God�s timing. Not open enough and we fester. Open too long and we become a wound. If you speed up how a flower blooms, it appears to be escaping. If you slow down the way a crisis explodes what we know, it appears we are transforming. Hard as it is to embrace, crises are flowers opening what we refuse to open by ourselves. Mark Nepo