Research on StressRelated Growth: Current Status and Future Directions

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Research on Stress-Related Growth Current Status
and Future Directions

• Crystal L. Park
• University of Connecticut

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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, Caplans crisis theory
• 1980s, resilience

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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.

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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

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• 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 lifes 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

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Domains of Growth

• Coping skills and strength
• Interpersonal relationships
• Life philosophy/Wisdom
• Spirituality and religiousness
• Appreciation for life
• Lifestyle behaviors

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Plan for Todays 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

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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

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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.

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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

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What do scores on self-reported growth
instruments signify?

• Without strong evidence of validity, these
  reports do not necessarily indicate growth, but
  rather peoples perceptions of their growth.

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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

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Constructs reflected in self-report measures of
growth
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Theories How does (veridical) growth occur?

• General theory of MEANING MAKING

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Model of Meaning-Making
Changes in Appraised Meaning of the Stressor,
Global Meaning, and the Discrepancy between Them
Global Meaning
Appraised Meaning of the Stressor
Yes
Discrepancy ?
Distress

Coping, including Problem and
Emotion- Focused Strategies Meaning Making
Deliberate and Unconscious
No
Resolution
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What is meaning making?

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

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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)

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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

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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

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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

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Some positive changes reported by survivors
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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)
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• Meaning making, Growth and other aspects of
  meaning, and Psychological well-being

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Cross-sectional Model
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Longitudinal Model
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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

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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)

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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

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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 Afflecks proposal-prospective

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Cutting Edge Issue 2

• The meaning of positive life changes and growth
  following stressful encounters

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The meaning of growth following illness

• Examine the extent to which perceptions of growth
  are related to aspects of psychological and
  physical well-being

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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

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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

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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?

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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.

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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?

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• How does growth come about? What is the role of
  cognitive processes such as intentionally
  searching for or reminding ones 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)?

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• 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

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Conclusions

• Two notes of caution
• Just because someone says that they have grown
  doesnt 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.

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Gods 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.

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• While there are terrible ways to be opened, there
  is no such thing as a bad opening. Its all about
  Gods 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