The effects of mortality reminders on posttraumatic growth and finding benefits among patients with life-threatening illness and their caregivers

Individuals confronted with a life-threatening illness often report posttraumatic growth (PTG) or finding benefits in disease. These positive evaluations of personal strength, perceptions of improved personal relations and new possibilities may represent a defensive response (cf Janus-face model). Three studies investigated the effects of mortality reminders on reports of PTG or benefit findings among people living with life-threatening illness or their caregivers. 80 people living with HIV (study 1), 164 breast cancer survivors (study 2) and 50 family caregivers for a patient with huntington disease (study 3) were randomly assigned to the experimental (mortality reminders) or control conditions. Across three studies, those exposed to mortality reminders reported lower PTG or benefit finding, compared to the controls. These effects were moderated by time elapsed since diagnosis: mortality reminders led to lower PTG/benefit finding among those who received the diagnosis more recently. The results provide an insight into the defensive character of PTG/finding benefits in illness and changes in the function of these beliefs over time elapsing since diagnosis.     

Posttraumatic Growth and Subjective Well-Being among Caregivers of Chronic Patients: A Preliminary Study

This preliminary study focused on positive phenomena among Israeli family caregivers (spouse, adult child, or parent) of patients with chronic illness hospitalized in a medical rehabilitation hospital. We investigated these caregivers’ posttraumatic growth (PTG) and subjective well-being (positive and negative emotions, life satisfaction), and their associations with the demographic and illness characteristics of the caregivers and patients, respectively. Participants included 74 adult primary caregivers: 28 were the patient’s spouse; 21 were the patient’s child; and 25 were the patient’s parent. Caregivers completed four self-report questionnaires. No significant association emerged between caregivers’ PTG and their negative affect or life satisfaction. Nevertheless, caregivers’ positive affect correlated with their PTG and also predicted it. Moreover, different patterns emerged for the caregiver subgroups (spouse, adult child, or parent): Patients’ children reported lower negative affect and greater life satisfaction than patients’ parents or spouses. Various explanations were discussed, alongside implications for giving recognition and assistance from the medical system to patients’ caregivers.     

The role of mortality awareness in hero identification

Three studies examine hypotheses derived from terror management theory to investigate the relationship between mortality concerns and hero identification. Study 1 found reminders of death, followed by a distraction task and a self-prime, led to greater inclusion of heroes in the self. Study 2 found that writing about a personal hero, but not other’s heroes or acquaintances, led to lower death-thought accessibility after being reminded of mortality. Finally, Study 3 found that after death reminders, participants led to identify with a hero exemplifying traits of legacy and/or sacrifice showed lower death thought accessibility. Findings are discussed as generative for heroism research, informing a previously overlooked motivation underlying hero identification and the existential function of such identification.     

The Impact of Stigma and Social Support on Development of Post-traumatic Growth Among Persons Living with HIV

Given high rates of trauma in people living with HIV (PLH) and the health benefits of posttraumatic growth (PTG), understanding how to foster PTG in PLH exposed to trauma could be of interest to clinical psychologists working with this population. The current study examined factors theoretically related to development of PTG in PLH, namely HIV-related stigma, disclosure of HIV status, and emotional support. A sample of 334 HIV-positive adults answered a battery of self-report questionnaires. HIV-related stigma, disclosure to sexual partners, and emotional support were significant predictors of PTG: stigma was associated with lower PTG, whereas disclosure and emotional support were associated with higher PTG. Disclosure and emotional support remained significantly associated with PTG in the model including demographic factors and stigma. These findings highlight the need for development of interventions that can aid PLH in disclosing their HIV status to sexual partners and increasing available social support.     

Defensive pride and consensus: strength in imaginary numbers

Failure (Study 1) and attachment separation thoughts (Study 2) caused exaggerated consensus estimates for personal beliefs about unrelated social issues. This compensatory consensus effect was most pronounced among defensively proud individuals, that is, among those with the combination of high explicit and low implicit self-esteem (Study 1) and the combination of high attachment avoidance and low attachment anxiety (Study 2). In Study 3, another form of defensive pride, narcissism, was associated with exaggerated consensual worldview defense after a system-injustice threat. In Study 4, imagined consensus reduced subjective salience of proud individuals' troubling thoughts. Compensatory consensus is seen as a kind of defensive self-affirmation that defensively proud people turn to for insulation from distressing thoughts.     

创伤后成长的促进因素、模型及干预

创伤后成长(Post-traumatic Growth, PTG)是指人们在经历了严重的压力性生活事件或创伤性事件后, 由于对抗压力所引起心理的积极变化。本研究对国外创伤后成长进行归纳概括, 论述了促进创伤后成长的影响因素, 如人格特质、社会支持、益处寻求和意义建构。此外, 归纳了基于不同视角的PTG模型, 提出了促进PTG的干预策略, 针对PTG实证研究中某些相关变量的测量问题提出改进意见。未来应着重于开展具备多个评估点的纵向研究, 建构适用于不同人群的PTG理论模型。     

The nature of benefit finding in multiple sclerosis (MS)

This study examined the nature of benefit finding in MS and the adequacy of the Benefit Finding Scale (BFS; Mohr et al., 1999) as a comprehensive measure of perceived benefits in MS. A total of 502 people with MS completed questionnaires at Time 1 and 3 months later, Time 2 (n=404). Data on demographics and illness were collected at Time 1 and qualitative data on benefit finding was obtained at Time 2. Content analyses revealed seven benefit finding themes (personal growth, strengthening of relationships, appreciation of life, new opportunities, health gains, change in life priorities/goals and spiritual growth). Two of the themes were represented by several items on the BFS (personal, relationship growth), three were not reflected by items on the BFS (health, new opportunities, life priorities) and two were represented by one item each (spiritual, life appreciation).     

Does Posttraumatic Growth Buffer the Association Between Death Anxiety and Quality of Life Among People living with HIV/AIDS?

People living with HIV (PLWH) may experience death anxiety (DA), which can be detrimental to quality of life. Posttraumatic growth (PTG), however, is antithetical to DA, with its positive attributes at odds with negative psychosocial outcomes. Previous research has not examined the buffering effect of PTG on the association between DA and quality of life. Therefore, in addition to the direct effects of DA and PTG on health-related quality of life (HRQoL), we investigated the moderating role of PTG on the relationship between DA and HRQoL among people living with HIV/AIDS (PLWH) in Nigeria. Using cross-sectional design and availability sampling method, we selected 201 outpatients (men, n?=?63, 31.3%, women, n?=?138, 68.7%, mean age?=?40.1, SD?=?10.5) managed for HIV/AIDS in a Nigerian tertiary healthcare institution. Death Anxiety Inventory-Revised, Posttraumatic Growth Inventory-Short Form, and Patient-Reported Outcome Quality of Life-HIV were used to access DA, PTG and HRQoL, respectively. Results showed that while adjusting for socio-demographic factors (age, gender, time since diagnosis and educational status), DA was associated with physical health, mental health and social relationships domains of HRQoL as well as overall HRQoL. In contrast, PTG did not evidence significant association with HRQoL dimensions and overall HRQoL. The moderation effect of PTG on the association between DA and HRQoL was not supported. Independent of PTG, alleviating DA may be an important target in terms of therapeutic intervention towards improving quality life of PLWH.

     

Psychoeducational Intervention Program about Posttraumatic Growth for Japanese High School Students

This study evaluates the effect of a psychoeducational intervention about posttraumatic growth (PTG) among Japanese adolescents. Study 1 examined whether those who learned about changes related to stress would report higher growth than those who did not. Study 2 examined whether those who learned about PTG perceived more growth than those who learned about negative changes or those who did not learn about potential changes. Findings from both studies indicated that PTG was higher in those who received the intervention program than those who did not. These studies demonstrate the potential effectiveness of a psychoeducational intervention program in fostering adolescents’ perceptions and understanding of their personal growth following stressful experiences. Implications are that the knowledge about not only stress reactions or coping but the possibility of PTG can be integrated into the health education.     

Why do people need self-esteem? A theoretical and empirical review

Terror management theory (TMT; J. Greenberg, T. Pyszczynski, & S. Solomon, 1986) posits that people are motivated to pursue positive self-evaluations because self-esteem provides a buffer against the omnipresent potential for anxiety engendered by the uniquely human awareness of mortality. Empirical evidence relevant to the theory is reviewed showing that high levels of self-esteem reduce anxiety and anxiety-related defensive behavior, reminders of one's mortality increase self-esteem striving and defense of self-esteem against threats in a variety of domains, high levels of self-esteem eliminate the effect of reminders of mortality on both self-esteem striving and the accessibility of death-related thoughts, and convincing people of the existence of an afterlife eliminates the effect of mortality salience on self-esteem striving. TMT is compared with other explanations for why people need self-esteem, and a critique of the most prominent of these, sociometer theory, is provided.     

Posttraumatic Growth Among HIV/AIDS Patients1

Correlates (n= 835 at Time 1) and predictors (n= 434 at Time 2) of posttraumatic growth (PTG; perceiving positive life changes stemming from diagnosis) over 1.6 years were examined among a diverse sample of HIV/AIDS patients. PTG was common–59% of participants reported to have experienced at least moderate positive changes since diagnosis. At Time 1, PTG had significant negative associations with age, alcohol use, depression, and pessimism; and positive associations with African American ethnicity (vs. White), female gender, eating a healthy diet, and optimism. At Time 2, religiosity was positively associated with PTG. The process of experiencing PTG over time was associated with lower levels of depression over time. Although the underlying process of PTG remains unclear, these results suggest that PTG is worthy of intervention focus.     

Spirituality,Distress and Posttraumatic Growth in Breast Cancer Patients

Breast cancer is the most common type of cancer for women and is associated with increased distress. Spirituality and posttraumatic growth (PTG) have been associated with illness adjustment, but the relationship between these variables is still not well understood. A sample of 100 breast cancer patients completed a demographic and clinical questionnaire, the Posttraumatic Growth Inventory, Spiritual and Religious Attitudes in Dealing with Illness, and the Hospital Anxiety and Depression Scale. Results showed an association between PTG, spirituality and distress. Women with a longer diagnosis and recurrence showed more distress. Younger age, recurrent cancer and spirituality predicted higher PTG. Patients’ spirituality should be part of intervention with breast cancer patients since it seems to be related to greater growth and adjustment to the illness.     

Terror Management and Personality: Variations in the Psychological Defense Against the Awareness of Mortality

Drawing on terror management theory (TMT), we discuss the psychological motivations that shape personality at two levels: the characteristically human personality common to us all and the individual differences that distinguish some people from others. TMT posits that the motivation to protect the self against deep-rooted fears about mortality drives people to maintain meaningful, reliable conceptions of reality and positive evaluations of themselves, two broad tendencies that form the foundation of every person’s personality. We review studies showing that mortality reminders increase efforts to bolster cultural sources of meaning and self-esteem in similar ways across individuals and cultures. TMT also posits that individual differences in personality partly reflect the different sources of meaning and self-esteem that people invest in to assuage mortality fears. We review evidence that individual differences predict the degree and direction of people’s defensive responses to mortality reminders. Directions for future research are discussed.     

The body as a source of self-esteem: the effect of mortality salience on identification with one's body, interest in sex, and appearance monitoring

The present research investigated the role of the physical body as a source of self-esteem and tested the hypothesis derived from terror management theory that reminding people of their mortality increases self-esteem striving in the form of identification with one's body, interest in sex, and appearance monitoring. The results revealed that individuals high in body esteem responded to mortality salience manipulations with increased identification with their physical bodies in Study 1 and with increased interest in sex in Study 2. Study 3 showed that reminders of death led to decreased appearance monitoring among appearance-oriented participants who were low in body esteem. These findings provide insight into why people often go to extreme lengths to meet cultural standards for the body and its appearance.     

The effects of psychological security and insecurity on political attitudes and leadership preferences

Recent research from different perspectives suggests that uncertainty, mortality salience (MS), and other fundamental threats that cause feelings of insecurity motivate people to adhere to specific kinds of anxiety‐reducing political attitudes and values. In the current studies, we examined a complementary prediction that providing people with an alternative source of security would reduce their need to defend against insecurity, resulting in lower endorsement of the anxiety‐reducing political attitudes. Results supported this prediction, showing that security primes buffered or reversed the effects of insecurity and threats on political attitudes and leadership preferences. Participants primed with attachment security showed reduced liking of a strong, charismatic political candidate (Study 1), and lower support for the Iraq war, even in the face of mortality reminders (Study 2). We discuss these findings in the context of research on motivated social cognition, political psychology, and the effects of security and insecurity on attitudes and behaviors. Copyright © 2009 John Wiley & Sons, Ltd.     

Mortality salience increases language style matching and well-being

The present research examined whether people imitate the language style of others (i.e., the use of function words) as a form of liking when mortality concerns are salient. In Study 1, participants answered questions about death or public speaking and then engaged in an instant messaging conversation with a confederate. In Study 2, participant pairs verbally discussed a news article about increasing homicide rates or the rise in academic pressure. Next, everyone completed measures of self-esteem, life satisfaction, and relationship need satisfaction. The results revealed that, in comparison to the control conditions, participants exhibited greater language style matching (LSM) following reminders of death (Studies 1 & 2). Further, mediational analyses showed that higher LSM after mortality salience was associated with better psychological and social well-being (Study 2). Although the threat of death has been shown to make people more hostile and disparaging toward dissimilar others, the present work suggests that individuals, even strangers, may feel closer through language coordination following thoughts of mortality.     

Common sense epidemiology: self-based judgments from laypersons and physicians

This article reports two studies on a neglected aspect of common sense epidemiology: subjective estimates of the prevalence of symptoms and diseases. Based on social-psychological research on the false-consensus effect, it was hypothesized that subjects who had a history of a condition would estimate its prevalence to be greater than would subjects who did not have a history of that condition. This hypothesis was supported across several different symptoms and diseases. Expertise did not confer protection from the effect. It occurred among 110 college students in Study 1 as well as among 65 practicing physicians in Study 2. In addition, college students who estimated the prevalence of a condition as relatively high rated that condition as less life-threatening than did other students, and students who had a history of a condition rated it as less life-threatening than did their counterparts without such a history. The discussion focuses on (a) explanations of differences in prevalence estimates as a function of personal health history, (b) implications for laypersons' judgments of seriousness, their emotional reactions to illness threats, and their illness behavior, and (c) implications for physicians' diagnostic behavior.     

Commonly-defined and individually-defined posttraumatic growth in the US and Japan

Posttraumatic growth (PTG) is the experience of positive change resulting from the struggle with major life crises. Research on PTG has relied on instruments such as the Posttraumatic Growth Inventory (PTGI: Tedeschi &; Calhoun, 1996), in which items that describe positive changes are assumed to represent personal growth equally for all people. However, some positive changes may indicate greater growth for some people. Individually-defined PTG may differ from commonly-defined PTG. The purpose of this study was to explore the relationships between these two definitions of PTG and how culture affects them. Participants from the US (n = 456) and Japan (n = 279) indicated the degree to which each change in the PTGI represented personal growth. Results from mixed-model analyses of variance revealed that there were main effects for defined growth as well as interaction effects for all PTGI factors. For example, US participants reported greater growth on the factors Relating to Others and New Possibilities for the commonly-defined level, but once individually-defined PTG was considered, growth scores for US participants decreased substantially, and more so than for Japanese participants. Discussion addresses cultural and individual differences in the subjective definitions of PTG and highlights several directions for future research.     

Terror management and attributions of blame to innocent victims: reconciling compassionate and defensive responses

In this article, 4 studies test the hypothesis that reminders of personal death bias the normative attribution process and increase the motivation to blame severely injured, innocent victims. In Studies 1 and 2, primes of death led to greater attributions of blame to severely injured victims but did not significantly influence attributions of blame to either mildly injured victims or negatively portrayed others. In Study 3, primes of death led to greater attributions of blame to victims of circumstance but did not influence attributions of blame to victims who were explicitly responsible for their condition. In Study 4, innocent victims who were severely injured elicited more death-related cognitions than did victims who were responsible for their condition or who were only mildly injured. These findings indicate that the predictions of normative models of attribution may be moderated, and even overturned, when observers are reminded of their personal death such that defensive needs override rational inferential processes.     

Thai Women: Meditation as a Way to Cope with AIDS

Mental-health professionals often ignore the spirituality and religious beliefs that can aid a person's ability to cope with a life-threatening illness such as HIV/AIDS. As the physical body succumbs to the disease, people with HIV/AIDS search for ways to lower their stress, regain control of their health, attain some peace of mind, and hope to prolong their survival. This sense of personal control is important when dealing with chronic or terminal illness. The purpose of this study was to explore the role of meditation in Thai Buddhist women who are infected with HIV/AIDS. Interviews were conducted with 26 Thai women living in the northern part of Thailand known as Chiang Mai, where the incidence of AIDS is the highest in Southeast Asia. Although the scope of this study is limited and not generalizable, it supports the idea that a spiritual approach to healing, in conjunction with conventional medical treatment, is a source of great comfort to persons living with HIV/AIDS and may influence immune functioning.