Making sense of loss and benefiting from the experience: two construals of meaning

The Strength-Based Counseling Model

This article proposes a strength-based model for counseling at-risk youth. The author presents the assumptions, basic concepts, and values of the strength perspective in counseling and offers strength categories as a conceptual model for viewing clients’ behavior. Propositions leading toward a theory of strength-based counseling and stages of this model are given, representative strength-based counseling techniques are examined, and a case study is used to illustrate risk factors, protective factors, and strength assessment. Ethical, research, and training implications of the strength-based model of counseling are discussed.

Exploring the Relationship Among Posttraumatic Growth, Life Satisfaction, and Happiness Among Korean Individuals With Physical Disabilities

A growing body of empirical evidence has demonstrated that individuals who experience traumatic and stressful life events can experience positive psychological changes as a result of their struggles with adversity, stress, and trauma. The purpose of the current study is to examine the relationship among five domains (e.g., as relating to others, recognition of new possibilities, a feeling of personal strength, and spiritual change) of posttraumatic growth, happiness, and life satisfaction among Korean individuals with physical disabilities. The results of this study show that three factors (i.e., recognition of new possibilities, experience of spiritual growth, and an appreciation of life) served as predictors of life satisfaction, and two factors (i.e., recognition of new possibilities and personal strength) predicted happiness. This result suggests that certain factors of posttraumatic growth can lead to particular health benefits and influence these benefits to varied extents.

Posttraumatic Growth and Bereavement

No research drawing from Self-Determination Theory has investigated the bereavement experience of individuals or how motivation can help facilitate posttraumatic growth (PTG) following the death of a loved one. In two cross-sectional studies, university students completed an online survey. Study 1 investigated the contribution of global autonomous and controlled motivation in statistically predicting PTG above and beyond previously researched correlates. Study 2 explored the mediating role of cognitive appraisals and coping in explaining the relationship between global motivation orientations and PTG. Results indicated that in comparison to controlled motivation, autonomous motivation was positively related PTG, even after controlling for previously researched correlates. Mediation results indicated an indirect effect of global autonomous motivation on PTG through task-oriented coping. Collectively, these findings suggest the importance of incorporating motivation into models of PTG. Clinical implications of these findings are also discussed.

Transactional Experiences of Existential Anxiety as a Barrier to Effective Humanistic Intervention

There are some who criticize mainstream mental health approaches and point out that individuals in distress appear to be getting worse, as opposed to better, while in treatment. Ex-patients often advocate for a person-centered, humanistic approach to working with emotional distress, while clinicians tend to offer a disease-based, deficit-focused model. This article is an exploration of the dynamics between patients and professionals that may be contributing to conflicting perspectives on what constitutes helpful intervention. Specifically, concepts of terror management theory are used to explore how the existential anxieties experienced both by individuals with serious emotional difficulties as well as their treating clinicians, which are consciously or unconsciously avoided in treatment, can reciprocally trigger distressing anxiety in the other. Suggestions are offered as to what could help mitigate this existential stalemate in the psychotherapeutic context.

Meaning Reconstruction in the Wake of Loss: Evolution of a Research Program

As theories of bereavement have evolved, so too have evidence-based interventions to mitigate complications in post-loss adaptation. This article reviews one line of programmatic research grounded in a conceptualisation of grieving as an attempt to reaffirm or reconstruct a world of meaning challenged by loss. Anchored in therapeutic encounters with the bereaved, a meaning reconstruction approach to loss has grown over the past 15 years to generate an increasingly substantial research base, as well as to develop and refine a wide array of contributions to psychological assessment and therapy. By summarising the major models, measures and methods resulting from this collaborative work, it offers an introduction to meaning reconstruction for those unfamiliar with it, noting its contributions to date, its areas of future development, and its relevance for clinical practice.

[The role of intrusive and deliberate ruminations for meaning making in stressful events]

This study examined the relationship between meaning making and rumination regarding stressful events. We focused on two facets of rumination: intrusive and deliberate. Participants (N = 121) completed a questionnaire about a stressful event in their life that assessed the possibility of preventing the event, probability of the event occurring, perceived threat of the event, and meaning making. They also completed scales that assessed intrusive and deliberate ruminations about the event, posttraumatic growth after the event, as well as dispositions of self-rumination and self-reflection, and executive function. The results revealed that disposition of self-reflection was positively correlated with deliberate rumination about the event. Furthermore, deliberate rumination at the time of the experience was positively correlated with current positive meaning making, which was associated with current posttraumatic growth. Additionally, current intrusive rumination promoted current negative meaning making, but intrusive rumination at the time of the experience did not. Thus, this study suggests the important role of both intrusive and deliberate ruminations in the process of meaning making and several issues for future research.

The feeling of the story: Narrating to regulate anger and sadness

Admonitions to tell one's story in order to feel better reflect the belief that narrative is an effective emotion regulation tool. The present studies evaluate the effectiveness of narrative for regulating sadness and anger, and provide quantitative comparisons of narrative with distraction, reappraisal, and reexposure. The results for sadness (n = 93) and anger (n = 89) reveal that narrative is effective at down-regulating negative emotions, particularly when narratives place events in the past tense and include positive emotions. The results suggest that if people tell the "right" kind of story about their experiences, narrative reduces emotional distress linked to those experiences.

Coping with breast cancer: Reflections from Chinese American, Korean American, and Mexican American women

OBJECTIVE

The present study identified and compared the coping strategies of Chinese American, Korean American, and Mexican American breast cancer survivors (BCS).

METHODS

Six focus groups were conducted with Chinese American (n = 21), Korean American (n = 11), and Mexican American (n = 9) BCS. Interviews were audio-recorded, transcribed, and translated for thematic content analysis of coping experiences and strategies.

RESULTS

Women reported the use of 8 coping strategies (religious/spiritual, benefit finding, fatalism, optimism, fighting spirit, information seeking, denial, and self-distraction). Among Chinese American BCS, benefit finding was the most referenced coping strategy, whereas religious/spiritual coping was most frequently reported among Korean American and Mexican American BCS. Denial and self-distraction were the least cited strategies.

CONCLUSIONS

Survivors draw upon new found inner strength to successfully integrate their cancer experience into their lives. Coping models must consider the diversity of cancer survivors and the variability in coping strategies among cultural ethnic minority BCS.

Bereaved families and the coronial response to traumatic workplace fatalities: Organizational perspectives

Work remains a significant source of illness, injury, and death in developed countries. In Australia, for example, over 2,000 people die from work-related causes each year, with heavy social, economic, and personal costs (Safe Work Australia, 2013a ). Most die as a result of work-related disease. However, many die from trauma. In 2012, 223 workers were fatally injured in Australia and in the United States the figure was 4,383 (Bureau of Labor Statistics, 2014 ; Safe Work Australia, 2013b ). Apart from the immediate tragedy of each worker's death, these deaths affect the victim's immediate family, wider family, friends, and co-workers. It has been estimated that, on average, every death has an impact on at least 20 other people (Dyregrov, Nordanger, & Dyregrov, 2003 ), especially when the deceased had several families, which is an increasingly common phenomenon (OECD, 2014 ). Little is known, however, about how regulatory responses following a traumatic workplace fatality meet the needs of surviving families. With a focus on the coronial investigation, this article provides information about the regulatory responses to a traumatic workplace fatality and examines how various organizations involved in the coronial process following the death viewed its ability to accommodate the needs and wishes of surviving families.

Posttraumatic growth among spouses of combat veterans: Adaptive or maladaptive for adjustment?

We examined the relationship between posttraumatic growth (PTG) and distress in spouses of trauma survivors. A sample of spouses of combat veterans of the 1973 Yom Kippur War were assessed using questionnaires pertaining to PTG, depression, anxiety, and posttraumatic stress, in 2004 and 2011. Applying cross-lagged modeling strategy, higher PTG levels predicted higher depression and anxiety levels above and beyond initial distress. Thus, psychological growth in spouses of survivors appears to signify subsequent distress.

What Gives Meaning in Life to Patients With Advanced Cancer? A Comparison Between Spanish, German, and Swiss Patients

CONTEXT

Meaning in life (MiL) is a construct that varies across individuals, situations, cultures, and countries, and protects against emotional distress at the end of life.

OBJECTIVES

To examine MiL in inpatients with advanced cancer from Barcelona, Spain, and to compare the findings with those obtained in German and Swiss samples.

METHODS

This was a cross-sectional study in which the Schedule for Meaning in Life Evaluation (SMiLE) was administered. The SMiLE asks respondents to list individual areas that give meaning in their lives and then to rate their current level of importance and satisfaction with the listed areas.

RESULTS

A total of 101 inpatients completed the SMiLE. The Index of Satisfaction was 76.8 ± 21.1, the Index of Weighting was 88.0 ± 13.0, and the Index of Weighted Satisfaction was 76.9 ± 20.7. Family, partnership, well-being, and friends were the four areas listed by the largest proportion of Spanish patients. Compared with the German sample, Spanish patients were more likely to list well-being (P < 0.01) and pleasure (P < 0.05) and less likely to list animals/nature, leisure time, and finances (P < 0.01). With respect to their Swiss counterparts, Spanish patients were more likely to list health (P < 0.01) and less likely to list friends, leisure time, animals/nature, and finances (P < 0.01).

CONCLUSION

Differences were identified in the areas of MiL listed by the participants according to country of origin. Compared with their German and Swiss counterparts, the Spanish patients listed more areas involving interpersonal relationships. Interpersonal relationships, at both the family and wider social level, are reported to be the areas that give the greatest MiL to these patients. These aspects, therefore, should be considered when drawing up care plans designed to help patients achieve the maximum possible comfort and quality of life.

The central role of meaning in adjustment to the loss of a child to cancer: implications for the development of meaning-centered grief therapy

PURPOSE OF REVIEW

This review describes research on meaning and meaning-making in parents who have lost a child to cancer, suggesting the need for a meaning-centered therapeutic approach to improve their sense of meaning, purpose, and identity and help with management of prolonged grief symptoms.

RECENT FINDINGS

Several studies have demonstrated that parents bereaved by cancer experience unique meaning-related challenges associated with the caregiving and illness experience, including struggles with making sense of their loss, benefit-finding, their sense of identity and purpose, disconnection from sources of meaning, and sustaining a sense of meaning in their child's life. Meaning-centered grief therapy, adapted from meaning-centered psychotherapy, directly addresses these issues, highlighting the choices parents have in how they face their pain, how they honor their child and his/her living legacy, the story they create, and how they live their lives.

SUMMARY

Given the important role that meaning plays in adjustment to the loss of a child to cancer, a meaning-focused approach such as meaning-centered grief therapy may help improve parents' sense of meaning and grief symptoms. It seems particularly appropriate for parents who lost a child to cancer because it does not pathologize their struggles and directly targets issues they frequently face.

Posttraumatic Growth in Widowed and Non-widowed Older Adults: Religiosity and Sense of Coherence

Older people may experience psychological growth following a life major event. The objective of this study is to analyze the degree of posttraumatic growth (PTG) developed by widowed and non-widowed older adults (n = 103) as well as the impact of possible predicting variables such as sociodemographic characteristics, experienced or witnessed life major events, religiosity and sense of coherence. The findings suggest that, in spite of widowhood, elder people develop PTG in the same way that non-widowed elder people. Therefore, the support of a religious community, age, life major events experienced and the subjective meaning given to them correlated with PTG.

[Sense making affects stress response processes in parents of children with developmental disorders]

This study examined the stress-buffering effects of sense making among parents of children with developmental disorders. A model assuming that social support is related to sense making and that coping strategy mediates sense making and stress response was examined via a questionnaire survey of mothers of children with developmental disorders (N = 245). The results of structural equation modeling analysis suggested the following: (a) the stress-buffering effects of sense making were mediated through an emotional approach coping strategy and sense making was positively related to stress response mediated through an active coping strategy; (b) seeking a meaning directly increased one's stress response, which was indirectly mediated by an avoidant coping strategy; and (c) the effects of social support on sense making and coping strategy, as well as stress response, varied with the kind of social resources from whom mothers anticipated support. These results suggest that sense making affects stress response in mothers of children with developmental disorders through the social support they anticipate and the coping strategies they adopt.

The Benefits of Goal Adjustment Capacities for Well-Being Among Women With Breast Cancer: Potential Mechanisms of Action

Breast cancer can seriously disrupt a person's important life goals. As such, the ability to adjust one's goals may be critical for well-being. The present study investigated the relationships between disengagement/reengagement capacity and well-being among women with breast cancer, as well as several potential mechanisms (intrusive thoughts, life purpose, and physical activity) that could explain these relationships. The sample consisted of 230 women with early-stage (n = 172) or late-stage (n = 58) breast cancer, who were followed prospectively for 8 months. Well-being measures consisted of global mental health, perceived physical health, positive/negative affect, and sleep efficiency. Disengagement capacity did not predict any outcome variable. In contrast, reengagement capacity prospectively predicted changes in global mental health, positive affect, negative affect, sleep efficiency, life purpose, and physical activity. Life purpose mediated the prospective relationship between reengagement capacity and multiple aspects of well-being. The relationships between purpose and positive/negative affect were reciprocal over time. Results also suggested that physical activity is not a mediator, but is in fact a result of the effect of reengagement capacity on well-being. The results demonstrate that reengagement capacity is important for well-being among women with breast cancer.

Describing work as meaningful: towards a conceptual clarification

Purpose

– Providing employees with meaning in their work has inspired numerous researchers to study the role of personal meaningful work and its related outcomes. Despite this high level of interest, the theoretical views and methodological approaches used to explore this concept still require refinement and development. Without a comprehensive review of these views and approaches, the concept of meaningful work will remain an ill defined notion. The purpose of this paper is to address this gap with a review of the theoretical and empirical research on meaningful work.

Design/methodology/approach

– The paper includes a discussion on the concepts of “meaning” and “work”, and its importance and the sources for conceptual confusion, and a synthesis of the common features that form the idea of meaningful work in numerous empirical and theoretical studies.

Findings

– The paper found meaningful work is derived when the employee has a perfect understanding of the nature and expectations of the task environment (i.e. the work has a clear goal, purpose and value that is connected to the employee), the employee feels a sense of fit or congruence between their own core values and the job requirements and organizational mission and goals, and when perfect understanding exists of how employees’ roles contribute to the purpose of the organization.

Practical implications

– As part of an effective HRM strategy, organizations should actively encourage and develop managers’ abilities to redesign jobs and the climate to build enhanced feelings of meaning in work. Furthermore, organizations can promote greater experiences of meaningful work among employees by implementing the “job crafting” concept. Also, the role of top management is to focus on job elements that would possibly change personal needs of employees and hence perceive their jobs to be more meaningful.

Originality/value

– Given the limited amount of recent literature focused on defining meaningful work, this paper provides valuable resources to help organizations succeed in their understanding of how to engage in creating meaningful work environment. It also examines the underlying features that constitute the meaningful work concept and offers guidance for future research by presenting the current state of knowledge about meaningful work.

The role of rumination in posttraumatic stress disorder and posttraumatic growth among adolescents after the wenchuan earthquake

Three hundred and seventy-six middle school students in Wenchuan County were assessed three and one-half years after the Wenchuan earthquake to examine the effects of rumination on posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). The results revealed that recent intrusive ruminations partly mediated the relationship between intrusive rumination soon after the earthquake with PTSD but not with PTG. Recent deliberate rumination partly mediated the relationship between intrusive rumination soon after the earthquake and PTG but not PTSD. Moreover, recent deliberate rumination also partly mediated the relationship between recent intrusive rumination with PTG but not with PTSD. Overall, intrusive rumination soon after the earthquake had an effect on PTSD but not on PTG through recent intrusive rumination and affected PTG but not PTSD through deliberate recent rumination. Furthermore, intrusive rumination soon after the earthquake affected PTG but not PTSD by recent deliberate rumination following recent intrusive rumination. More importantly, the present study also found that PTSD exhibited no relation to PTG. These results suggest that PTSD and PTG are influenced by different mechanisms, which further indicates that PTSD and PTG represent two separate dimensions of experience after adversity.

Post-traumatic growth following acquired brain injury: a systematic review and meta-analysis

The idea that acquired brain injury (ABI) caused by stroke, hemorrhage, infection or traumatic insult to the brain can result in post-traumatic growth (PTG) for individuals is increasingly attracting psychological attention. However, PTG also attracts controversy as a result of ambiguous empirical findings. The extent that demographic variables, injury factors, subjective beliefs, and psychological health are associated with PTG following ABI is not clear. Consequently, this systematic review and meta-analysis explores the correlates of variables within these four broad areas and PTG. From a total of 744 published studies addressing PTG in people with ABI, eight studies met inclusion criteria for detailed examination. Meta-analysis of these studies indicated that growth was related to employment, longer education, subjective beliefs about change post-injury, relationship status, older age, longer time since injury, and lower levels of depression. Results from homogeneity analyses indicated significant inter-study heterogeneity across variables. There is general support for the idea that people with ABI can experience growth, and that various demographics, injury-related variables, subjective beliefs and psychological health are related to growth. The contribution of social integration and the forming of new identities post-ABI to the experience of PTG is explored. These meta-analytic findings are however constrained by methodological limitations prevalent in the literature. Clinical and research implications are discussed with specific reference to community and collective factors that enable PTG.

Cognitive neuroscience of human counterfactual reasoning

Counterfactual reasoning is a hallmark of human thought, enabling the capacity to shift from perceiving the immediate environment to an alternative, imagined perspective. Mental representations of counterfactual possibilities (e.g., imagined past events or future outcomes not yet at hand) provide the basis for learning from past experience, enable planning and prediction, support creativity and insight, and give rise to emotions and social attributions (e.g., regret and blame). Yet remarkably little is known about the psychological and neural foundations of counterfactual reasoning. In this review, we survey recent findings from psychology and neuroscience indicating that counterfactual thought depends on an integrative network of systems for affective processing, mental simulation, and cognitive control. We review evidence to elucidate how these mechanisms are systematically altered through psychiatric illness and neurological disease. We propose that counterfactual thinking depends on the coordination of multiple information processing systems that together enable adaptive behavior and goal-directed decision making and make recommendations for the study of counterfactual inference in health, aging, and disease.

Blended news delivery in healthcare: a framework for injecting good news into bad news conversations

Clinicians often inject good news into bad news delivery, and they do so for a variety of reasons. We present a framework that draws from research in the fields of health and social psychology to shed light on situations in which clinicians add superfluous good news into bad news conversations in an effort to ease the conversation or mitigate patients' distress, a broad strategy we refer to as blended news delivery. Our framework includes predictors of clinicians' use of blended news delivery, characteristics of blended news and outcomes of this strategy for both patients and clinicians. This framework addresses a common aspect of health communication and can direct future research on ideal strategies for and likely consequences of blended news delivery and communication more broadly.

Post-Traumatic Stress Symptoms and Post-Traumatic Growth: Evidence from a Longitudinal Study following an Earthquake Disaster

Objective

The current longitudinal study aims to examine the bidirectional relationship between post-traumatic stress symptoms (PTSS) and post-traumatic growth (PTG).

Method

One hundred twenty-two adults in the most severely affected area were investigated by self-report questionnaires at 12 months and 18 months after the Wenchuan Earthquake occurred in China.

Results

The autoregressive cross-lagged structure equation analysis revealed that PTG at 12 months post-earthquake could negatively predict PTSS at 18 months post-earthquake above and beyond PTSS stability, whereas PTSS at 12 months post-earthquake could not significantly predict subsequent PTG. Moreover, PTG at 12 months post-earthquake could predict fewer subsequent intrusions, numbing and hyper-arousal symptoms but not avoidance symptoms.

Conclusion

Growth can play a role in reducing long-term post-traumatic stress symptoms, and the implication of a positive perspective in post-trauma circumstance is discussed.

'You only have one chance to get it right': A qualitative study of relatives' experiences of caring at home for a family member with terminal cancer

BACKGROUND

Relatives looking after a terminally ill family member at home face numerous challenges. Studies into relatives' experiences of home caregiving have been criticised for their descriptive nature and lack of theoretical underpinnings.

AIM

To explore the emotional challenges faced by home caregivers, and their experiences of healthcare professionals, from the perspective of existential psychology.

DESIGN

A qualitative study using semi-structured interviews. Transcripts were analysed thematically using the Framework approach.

SETTING/PARTICIPANTS

The study took place within an inner-city London hospice. Participants (n = 15) were recently bereaved adult relatives of cancer patients who cared for their family member at home.

RESULTS

Participants' experiences of being a caregiver and of professional support were highly varied. The analysis generated 15 themes which were organised into a framework based on Yalom's four 'existential conditions': responsibility (e.g. 'being the linchpin of care'; 'you only have one chance to get it right'), isolation (e.g. 'being on my own', 'being held in mind'), death (e.g. 'knowing but not knowing') and meaningfulness (e.g. 'giving something back', 'acceptance and gratitude'). Healthcare professionals were perceived as influential in both helping and hindering relatives in meeting the challenges they faced.

CONCLUSION

Existential psychology provides a theoretical perspective from which to understand the psychological complexity of the emotional challenges home caregivers face and a framework which may usefully inform research and clinical practice. Professionals' attentiveness to caregivers' needs can have powerful effects in assuaging anxiety, reducing isolation and enabling relatives to connect with the meaningfulness of caregiving.

Benefit finding predicts depressive and anxious symptoms in women with breast cancer

PURPOSE

The aims of this study were to examine the psychometric properties of Chinese version of the Benefit Finding Scale (BFS-C) and to evaluate the effect of benefit finding on depressive and anxious symptoms in Chinese women with breast cancer.

METHODS

The English version of the Benefit Finding Scale was translated and back-translated prior to its administration. At the baseline assessment (T1), 658 women with breast cancer completed a demographic form, BFS-C, and Hospital Anxiety and Depression Scale (HAD). Then, 4 weeks later (T2), all the participants finished HAD again, and the BFS-C was re-administered to 100 patients who were randomly selected from the total sample.

RESULTS

The BFS-C exhibited moderate internal consistency and test-retest reliability. Five factors were extracted by principal component analysis: personal growth, worldview, family relationship, social relationship, and acceptance, and confirmatory factor analyses supported this five-factor model. Regression analyses showed that more benefit finding at T1 could predict less depressive and anxious symptoms at T2, accounting for 21.1 % and 15.3 % of variance, respectively. More worldview, family relationship, social relationship, and acceptance at T1 were associated with less depressive symptoms at T2, and more personal growth, worldview, family relationship, and acceptance at T1 were associated with less anxious symptoms at T2.

CONCLUSIONS

BFS-C is of good reliability and validity, and appropriate for assessing benefit finding in women with breast cancer. Worldview, family relationship, and acceptance are important contributing factors to depressive and anxious symptoms, which may be beneficial for women with breast cancer.

The role of the positive emotional attractor in vision and shared vision: toward effective leadership, relationships, and engagement

Personal and shared vision have a long history in management and organizational practices yet only recently have we begun to build a systematic body of empirical knowledge about the role of personal and shared vision in organizations. As the introductory paper for this special topic in Frontiers in Psychology, we present a theoretical argument as to the existence and critical role of two states in which a person, dyad, team, or organization may find themselves when engaging in the creation of a personal or shared vision: the positive emotional attractor (PEA) and the negative emotional attractor (NEA). These two primary states are strange attractors, each characterized by three dimensions: (1) positive versus negative emotional arousal; (2) endocrine arousal of the parasympathetic nervous system versus sympathetic nervous system; and (3) neurological activation of the default mode network versus the task positive network. We argue that arousing the PEA is critical when creating or affirming a personal vision (i.e., sense of one's purpose and ideal self). We begin our paper by reviewing the underpinnings of our PEA-NEA theory, briefly review each of the papers in this special issue, and conclude by discussing the practical implications of the theory.

Groups’ search for meaning: Redemption on the path to intergroup reconciliation

Four studies investigated the utility of finding meaning in past wrongdoing to promote intergroup reconciliation. Studies 1a, 1b, and 2 demonstrated that prompting members of perpetrator groups to engage in redemption narratives increases collective guilt and willingness to make reparations—both important in obtaining victims’ forgiveness. Further, Study 2 suggests that redemption narratives (but not sense-making) increase willingness to reconcile and reduce perceived justification. Study 3 suggests that perpetrators’ redemption, but not simply sense-making, narratives led victims to perceive greater change in the perpetrator group and increased victims’ willingness to reconcile, but not forgive. Taken together, the present work highlights the potential for redemption narratives to serve as an intervention for past intergroup conflict, increasing the chance for intergroup reconciliation.

Resilience in adults with cancer: development of a conceptual model

OBJECTIVE

Resilience is a construct addressed in the psycho-oncology literature and is especially relevant to cancer survivorship. The purpose of this paper is to propose a model for resilience that is specific to adults diagnosed with cancer.

METHODS

To establish the proposed model, a brief review of the various definitions of resilience and of the resilience literature in oncology is provided.

RESULTS

The proposed model includes baseline attributes (personal and environmental) which impact how an individual responds to an adverse event, which in this paper is cancer-related. The survivor has an initial response that fits somewhere on the distress-resilience continuum; however, post-cancer experiences (and interventions) can modify the initial response through a process of recalibration.

CONCLUSIONS

The literature reviewed indicates that resilience is a common response to cancer diagnosis or treatment. The proposed model supports the view of resilience as both an outcome and a dynamic process. Given the process of recalibration, a discussion is provided of interventions that might facilitate resilience in adults with cancer.

Posttraumatic growth and demoralization after cancer: The effects of patients' meaning-making

Objective:

It is common for patients to experience positive and negative psychological changes (e.g., posttraumatic growth or demoralization) after being diagnosed with cancer. Although demoralization and posttraumatic growth are both related to meaning-making, little attention has been paid to the associations among these concepts. The current study investigated the relationship between demoralization, posttraumatic growth, and meaning-making (focusing on sense-making and benefit-finding during the experience of illness) in cancer patients.

Method:

Some 200 cancer patients (with lung cancer, lymphoma, or leukemia) at the MacKay Memorial Hospital in New Taipei completed the Demoralization Scale–Mandarin Version (DS–MV), the Chinese Posttraumatic Growth Inventory (CPTGI), and a self-designed questionnaire for assessing sense-making and benefit-finding.

Results:

Demoralization was negatively correlated with posttraumatic growth, sense-making, benefit-finding, and time-since-diagnosis. Multiple regression analysis showed that meaning-making had different effects on demoralization and posttraumatic growth. The interactions of sense-making with either benefit-finding or time-since-diagnosis significantly predicted demoralization. Individuals with relatively higher sense-making and benefit-finding or shorter time-since-diagnosis experienced less demoralization.

Significance of Results:

The suffering of cancer may turn on the psychological process of demoralization, posttraumatic growth, and meaning-making in patients. Cancer patients who evidenced higher posttraumatic growth experienced less demoralization. Trying to identify positive changes in the experience of cancer may be a powerful way to increase posttraumatic growth. As time goes by, patients experienced less demoralization. Facilitating sense-making can have similar effects. Cancer patients with less benefit-finding experience higher demoralization, but sense-making buffers this effect.

Quality of Life and Coping With Chronic Illness and Disability

Quality of life (QOL) has been one of the most commonly used constructs in the field of rehabilitation. More specifically, it has been viewed and studied as a process, measure, goal, and outcome in the domain of psychosocial adaptation to chronic illness and disability (CID). However, it has seldom been discussed in the contexts of community-level clinical interventive strategies or personal-level coping strategies. This article seeks to provide the reader with a better appreciation and understanding of (a) the temporal nature of QOL within both the community-level and personal-level contexts of interventions, (b) the temporal-oriented parallel nature of managing life stresses as viewed from both community- and personal-level perspectives, (c) the intricate nature of anticipating, managing, and coping with CID as viewed from three distinct temporal vantage points, and (d) the psychosocial benefits accrued from future-oriented, positively valenced, post-CID coping efforts and their salutary influence on QOL among people with CID. The article concludes with a brief review of several theoretical, clinical, and research implications, informed by the temporal nature of coping strategies and their effect on psychosocial adaptation to CID.

Health and writing: meaning-making processes in the narratives of parents of children with leukemia

There is literary evidence stating that expressive writing affects health outcomes. Nevertheless, the processes underlying its benefits remain unclear. In our previous article, we described the benefits of writing; in this article, we investigate the meaning-making processes underlying the traumatic experiences of parents of children with leukemia in off-therapy. We collected the writings of 23 parents and grouped them according to the parents' psychological outcome (low/good/high) with respect to anxiety, as assessed during a follow-up. We qualitatively analyzed the texts written by parents with good psychological outcomes to highlight their main meaning-making processes, that is, how they put into words the shattering experience, reordered the events, connected their emotions and the events, reevaluated the event, and reconstructed the time process. We found that parents with low/high outcomes articulated these processes differently. Furthermore, we discussed the uses and functions of written narration for each group.

Development and validation of the Perceived Life Significance Scale

A recent literature review of meaning and bereavement suggests a conceptual distinction between sense-making, or the integration of a loss with beliefs and narratives, and life significance, or perception of value associated with an aspect of one's life experience. The present study aims to develop and validate a new measure: the Perceived Life Significance Scale (PLSS). Exploratory (n = 353) and confirmatory (n = 483) factor analyses support three factors: active pursuit of goals and activities; emptiness/insignificance (reverse-scored); and receptivity to beauty in everyday life. The PLSS demonstrates convergent and discriminant validity with respect to general measures of meaning, negative affect, depression, and sense-making.

Exploring the genetic counselor's role in facilitating meaning-making: rare disease diagnoses

The main goal of the constructivist meaning-making framework is to encourage grief adaptation through the search for meaning in loss. Strategies to help patients construct meaning from their experiences may lead to positive adaptation. This strategy has been used in contemporary grief counseling, but it may also be beneficial in the genetic counseling scenario. The diagnosis of a rare genetic disorder often has considerable psychosocial impact as patients and families describe feelings of isolation and hopelessness. Negative experiences with healthcare providers often reinforce these feelings. Genetic counselors continue to provide education and psychosocial support to patients and families with rare genetic disorders, and meaning-making strategies may provide a framework for which to help patients and families adapt to these challenging diagnoses. In this paper I explore the background of meaning-making counseling strategy and describe an experience in which it was used for counseling a family with a child with Mowat-Wilson syndrome. I show how a meaning-making framework can help families explore and construct meaning from their experiences and encourage positive adaptation. I also address the possible limitations of this strategy and the need to share additional experiences with this counseling framework. Meaning-making can be another tool for genetic counselors to help guide families in their grief and adaptation to rare disease diagnoses. I also describe qualities and aspects of counseling through the lens of meaning-making and stress the importance of addressing psychosocial dimensions of rare disease diagnoses.

Accepting death as part of life: meaning in life as a means for dealing with loss among bereaved individuals

The purpose of this study was to investigate the relationship between the 3 dimensions of death acceptance (i.e., neutral, approach, and escape) and grief symptomatology, as well as whether the relationship between neutral acceptance and grief symptoms was mediated by meaning in life. Data were collected from 160 bereaved individuals. Only neutral acceptance was significantly associated with grief symptomatology; the relationship between the 2 variables was mediated by meaning in life. Participants who perceived death as a natural part of life reported having a greater sense of meaning in their lives, which, in turn, predicted lower grief symptomatology.

The Grief and Meaning Reconstruction Inventory (GMRI): Initial Validation of a New Measure

Although increasing numbers of grief theorists, researchers, and therapists have begun to focus on the quest for meaning in lives disrupted by loss, no convenient and psychometrically validated measure of meanings made specifically in bereavement has been available to guide their efforts. To construct such a measure, the authors began with a systematic content analysis of sense-making, benefit finding, and identity reconstruction themes gleaned from the narrative responses of a sample of 162 adults who were diverse in their age, ethnicity, relationship to the decedent, cause of death, and severity of their grief response. These were then formulated into a set of 65 candidate items in a Likert scale format representing the level of the respondent's endorsement of the item in the past week. Subsequent administration to a second sample of 300 bereaved respondents permitted factor analysis of this pilot version of the Grief and Meaning Reconstruction Inventory (GMRI), and reduced the items to 29, which loaded on 5 distinct factors, labeled Continuing Bonds, Personal Growth, Sense of Peace, Emptiness and Meaninglessness, and Valuing Life. Both the overall GMRI and its constituent factors showed good internal consistency and strong convergent validity in the form of negative correlations with established measures of bereavement-related negative emotions, symptoms of complicated grief, and more general psychological distress and mental health symptomatology, and positive correlations with grief related personal growth. The authors close by noting several specific research and clinical applications of the measure, which could play a useful role in testing and refining contemporary models of meaning made in the wake of loss.

[Stress-buffering effects of benefit finding on the psychological stress' response in mothers of children with developmental disorders]

This study describes the development and evaluation of the Benefit Finding Scale in Developmental Disorder Parenting (BFS-DDP). Using this scale, we examined the stress-buffering effects of identifying positive implications and benefits of having a child with developmental disorders in parents of such children. The BFS- DDP was developed from a questionnaire survey of mothers (N = 265) of children with developmental disorders. Exploratory and confirmatory analysis identified four factors: (a) "deepened relationships," (b) "changed life," (c) "changed life philosophy," and (d) "personal strength." These factors had high degrees of internal consistency. Furthermore, BFS-DDP scores significantly correlated with measuring optimism and meaningfulness, indicating good convergent validity. Hierarchical regression analysis showed that benefit finding significantly decreased stress response in the presence of high stressors. These results suggest that benefit finding may have a stress-buffering effect.

Violations of war: testing the meaning-making model among Vietnam veterans

OBJECTIVE

Posttrauma adjustment theories postulate that intense stressors violate people's beliefs about the world and perceived ability to achieve valued goals. Failure to make meaning from traumatic events exacerbates negative adjustment (e.g., PTSD), whereas success facilitates positive adjustment (e.g., stress-related growth). The current study aimed to test this model of direct and indirect effects among a sample of veterans.

METHOD

Vietnam veterans (N = 130) completed assessment measures in an online survey format. Participants were largely male (91%) and Caucasian (93%) with a mean age of 61 years.

RESULTS

Results supported basic model tenets, linking military stress severity to violations of beliefs and goals. In the final model, only goal violations carried indirect effects of severity on PTSD symptoms. Presence of and search for meaning carried a portion of the indirect effects between goal violations and both PTSD and stress-related growth.

CONCLUSION

Findings suggest that traumatic stress may disrupt people's goals and meaning-making may center on these disruptions.

Spirituality: what is its role in pain medicine?

BACKGROUND

For many years, spirituality has been regarded as an integral aspect of patient care in fields closely allied to pain medicine such as palliative and supportive care. Despite this, it has received relatively little attention within the field of pain medicine itself. Reasons for this may include a lack of understanding of what spirituality means, doubtfulness of its relevance, an uncertainty about how it may be addressed, or a lack of awareness of how addressing spirituality may be of benefit.

METHODS

A review of the literature was conducted to determine the changing conceptual frameworks that have been applied to pain medicine, the emergence of the biopsychospiritual approach and what that means as well as evidence for the benefits of incorporation of this approach for the management of pain.

RESULTS

Although the concept of spirituality is broad, there is now greater consensus on what is meant by this term. Many authors and consensus panels have explored the concept and formulated a conceptual framework and an approach that is inclusive, accessible, relevant, and applicable to people with a wide range of health conditions. In addition, there is accumulating evidence that interventions that address the issue of spirituality have benefits for physical and emotional health.

CONCLUSIONS

Given the firm place that spirituality now holds within other fields and the mounting evidence for its relevance and benefit for people with pain, there is increasing evidence to support the inclusion of spiritual factors as an important component in the assessment and treatment of pain.