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.     

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).     

A Comparison of Mood and Quality of Life Among People with Progressive Neurological Illnesses and Their Caregivers

The current study was designed to investigate differences in mood and a range of QOL domains among 423 patients and 335 caregivers of people with motor neurone disease (MND), Huntington’s disease (HD), Parkinson’s, and multiple sclerosis (MS). Patients and caregivers completed an anonymous questionnaire that evaluated their mood (anxiety, depression, fatigue, confusion) and QOL (physical, psychological, social, environment). The results demonstrated that caregivers of people with MND and HD experienced most problems with their mood and QOL compared to caregivers of people in the other illness groups. There were few differences in mood or QOL between patients and caregivers. Patients generally showed greater confusion, physical impairment, and psychological maladjustment. The findings suggest that educational and intervention programs need to be developed to help both patients and their caregivers to adjust and cope with these illnesses, particularly caregivers of people with MND and HD.     

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.

     

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.     

HIV infection associated post-traumatic stress disorder and post-traumatic growth--a systematic review

The phenomenon of post-traumatic stress has been well documented in the literature as a lasting mental health condition associated with exposure to traumatic life events. The diagnosis and experience of human immunodeficiency virus (HIV) disease may be such a trauma. On the other hand, the phenomenon of post-traumatic growth (PTG) has been described, whereby people show positive mental health growth in the face of such trauma. This systematic review was set out to explore post-traumatic stress disorder (PTSD) and PTG in people with HIV to monitor prevalence, measurement and efficacy of interventions to reduce stress and/or promote growth. Standardised review techniques were used to track reports on both PTSD and PTG. A total of 206 papers were retrieved from the PTSD and HIV searches, and 13 from the PTG and HIV searches. After reviewing the papers for inclusion according to adequacy and relevance criteria and to remove duplicates, 33 PTSD papers and three PTG were available for full coding. Prevalence of PTSD in HIV ranged from 5% to 74%, which were much greater than the 7-10% in the general population. Seven studies showed a relation between trauma and PTSD, while six showed a link between PTSD diagnosis and reduced antiretroviral treatment adherence. Women were more likely to be diagnosed with PTSD. Only three intervention reports were identified that fitted our inclusion criteria. All of these reported on psychological interventions for HIV+?individuals with trauma. The interventions utilised HIV education, training in coping techniques and support groups. Only coping interventions were shown to be effective. PTG was under researched but showed a promising avenue of study. There needs to be harmonised measurement and the evidence base would need strengthening in order to build on the understanding of the impact of PTSD and PTG over the course of HIV disease. There is good evidence to associate HIV diagnosis and experiences during the course of illness as traumatic. PTSD has been shown to be prevalent and there seems to be good evidence to incorporate standardised measures to track the course of the disorder. There is extremely limited evidence that interventions may affect the course of symptom experience. The evidence and insight into PTG show promise but is currently inadequate.     

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.     

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.     

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.     

Posttraumatic Growth in Individuals With Chronic Illness: The Role of Social Support and Meaning Making

This study aimed to assess the predictive nature of social support, meaning making (presence of meaning and search for meaning), and demographic factors on perceived posttraumatic growth (PTG) in a sample of adults living with chronic illness (N = 110). Regression analyses indicated that presence of meaning and gender served as the strongest predictors, together accounting for 22% of the variance in PTG. Presence of meaning also moderated the relationship between social support and PTG, supporting the unique contribution of meaning making on PTG.     

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.     

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.     

Impact of patient suffering on caregiver well-being: the case of amyotrophic lateral sclerosis patients and their caregivers

The impact of patient suffering on family caregivers is an understudied but important topic. This study of patients with amyotrophic lateral sclerosis (ALS) and their caregivers examined the associations of two components of patient suffering: patient physical symptoms, and mental distress, as well as the patient's support for the caregiver, with caregiver well-being. The sample consisted of 52 patients with ALS and their caregivers. Patients and caregivers each completed a structured survey assessing multiple domains including demographics, health, and well-being. Specifically, patients rated their own physical symptoms and mental distress. Caregivers rated their own daily affect, and the extent to which they perceived the patient as supportive. Caregivers also reported whether or not they had found any benefit in dealing with the patient's illness. Regression analyses yielded significant associations of patient distress with caregiver negative affect; patient support was associated with greater caregiver positive affect, and patient symptoms and support were associated with greater likelihood of caregiver benefit finding. There was a significant two-way interaction of patient symptoms by support, namely, benefit finding was not only more likely with greater physical suffering and patient support, but it was also the case that caregivers who perceived the care recipient as unsupportive could only find benefit when this person experienced intense physical suffering. Support interventions for ALS patients and their caregivers should devote particular attention to how caregivers may be affected by witnessing their loved one's sufferings, as well as identify and address challenges in support exchanges between caregivers and patients.     

Illness Perception and Well-Being Among Persons with Multiple Sclerosis and Their Caregivers

This study jointly examined illness beliefs held by persons with multiple sclerosis (PwMS) and caregivers in relation to well-being. A group of 68 PwMS and their caregivers completed the Revised Illness Perception Questionnaire, Psychological Well-being Scales, Satisfaction with Life Scale and Positive Affect and Negative Affect Schedule. Findings revealed that PwMS’ well-being was primarily predicted by their own illness beliefs, and that also caregivers’ well-being was primarily predicted by their own beliefs. Across the two groups, well-being was positively associated with their belief that they understood the disease, and inversely associated with their representations of negative emotions. In addition, among PwMS, well-being was inversely associated with the number of symptoms they specifically attributed to their illness, while among caregivers, well-being was positively associated with beliefs that treatment could control the disease. Based on the study findings, psychoeducational and cognitive-behavioral strategies are suggested to promote well-being among PwMS and caregivers.     

创伤事件的痛苦程度对创伤后成长的影响：核心信念挑战的作用

采用创伤事件终身经历问卷—学生版、核心信念量表、创伤后成长评定量表,对3所大学进行问卷调查,探索具体创伤事件痛苦程度与创伤后成长(PTG)的关系,并检验核心信念挑战在其中的中介作用。结果发现：(1)家人患病或死亡类的创伤事件痛苦程度可负向预测PTG,并以核心信念挑战为中介;(2)目睹他人或自身相关的创伤事件痛苦程度和自身受虐待类的创伤事件痛苦程度可正向预测PTG,并以核心信念挑战为中介;(3)自然灾害类的创伤事件痛苦程度和家庭冲突类的创伤事件痛苦程度与核心信念挑战和PTG都无显著相关。因此不同领域的创伤事件痛苦程度引发创伤后成长的可能性不同。     

Posttraumatic Stress,Posttraumatic Growth,and Satisfaction With Life in Military Veterans

Objective: Military veterans are more likely than civilians to experience trauma and posttraumatic stress disorder (PTSD). Research suggests, however, that some people who experience trauma, including veterans, report posttraumatic growth (PTG), or positive personal changes following adversity. In this study, we tested a comprehensive model of PTG, PTSD, and satisfaction with life in a veteran population, exploring the roles of challenges to core beliefs, types of rumination, sex, and time since event. Method: Data were collected via Amazon’s Mechanical Turk, an online crowdsourcing website, from veterans (N = 197) who had experienced a stressful event within the last 3 years (M = 16.66 months, SD = 12.27 months). Structural equation modeling was used to test an integrated conceptual model of PTG, PTSD, and satisfaction with life. Results: Results showed that challenge to core beliefs was directly associated with both deliberate and intrusive rumination. Deliberate rumination was positively related to PTG; intrusive rumination was positively related to symptoms of PTSD. PTG and PTSD, in turn, mediated the relationship between rumination styles and satisfaction with life; PTG was related to higher satisfaction with life; and PTSD was negatively related to satisfaction with life. Results failed to show differences on any model variables as a function of time since event or sex. Conclusion: Results indicate that the intentional facilitation of PTG may be a complementary and alternative option to the reduction of PTSD symptoms for improving satisfaction with life. Findings suggest that efforts to facilitate PTG should be focused on strategies for promoting deliberate rumination.     

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.