Motivation and emotion/Book/2011/Growth through adversity

Overview
"" Success is not our greatest achievement, but, rather, it is facing a difficult life challenge with dignity and integrity " (Viktor Frankl, 1959)"

Life presents traumatic events such as loss, serious illness, divorce, and failure, which make costly demands on an individual's personal resources. Yet there are broad differences in the way individuals respond to adversity. Why do some individuals experience personal growth in response to hardship? Why do others experience negative outcomes and poorer well being? What factors make the difference between coming through adversity unbeaten, or being overwhelmed?

How painful events are perceived can influence their impact on us. We can do little to prevent adversity occurring, however we can choose how we respond. Trauma occurs when a difficult experience causes physical or emotional distress, threat to life of self or loved ones, or is a major negative life disruption (Triplett, Tedeschi, Cann, Calhoun, & Reeve, 2011). Trauma can challenge core beliefs, and as a result cause them to be re-examined. The greater the trauma, the more intensely the need to examine core beliefs is likely to be felt, and the higher the likelihood of post-traumatic growth (Triplett et al., 2011). While no-one would choose for themselves or their loved ones to experience suffering or adversity, post-traumatic growth offers the hopeful proposition that suffering does not need to be purposeless or without meaning. It is suggested that the degree of challenge that a traumatic event contains is associated with how much potential for growth and creating deeper meaning it also offers (Janoff-Bulman, 2004). It is by no means suggested that this is a simple, or easy process. Working through trauma and re-defining core beliefs are tasks that are immensely challenging to a person's sense of self, identity and place in the world. However, these same characteristics mean that difficult life events and suffering may be a means through which greater meaning and sense of satisfaction in life may be found in due course (Anagnostopoulos, Slater, & Fitzsimmons, 2010).

Growth as a response to adversity can promote a greater sense of meaning and purpose in life, and in this way has been shown to have an indirect relationship with life satisfaction (Triplett et al, 2011). However, it is important to recognise that greater meaning in life due to post-traumatic growth and distress over the event can co-exist. The emphasis on the emergence of greater meaning does not imply that the situation becomes easy, or welcome. In the case of serious disease, a person may find meaning by becoming aware that they are stronger than they realised as they face the disease, or have better relationships than they realised, yet at the same time, can still feel extreme sadness and distress over having to deal with disease and its implications (Triplett et al, 2011).

The search for meaning
Born in Vienna in 1905, Viktor Frankl was interned in 1945 to three different concentration camps during World War 2. He was freed in 1945, but his parents, wife and brother died while in the camps. Frankl was a psychiatrist and existentialist philosopher before being sent to the death camps, and continued to carry out therapy within the camps. Frankl's Logotherapy is based on his experiences as a prisoner of war, where his beliefs were severely tested under extreme conditions (Frankl, 1959; Lantz, 1993). Frankl believed that each person's unique disposition (their natural talents and limitations), situation (the external circumstances and environmental context around them) and their position (their chosen attitudes and responses to those influences) combine to create a perspective on life and meaning that is unique to that person (Esping, 2010). While in the camps, Frankl applied this theory by fusing his dual identity as a social scientist and a sufferer, which allowed him to capture the experience in a unique way.

Frankl's autobiographical book Man's Search for Meaning (1959) was the foundation of post-traumatic growth theory. This influential book examines the human capacity to transcend suffering, trauma and adversity by finding meaning in even the most difficult of circumstances (Frankl, 1959). Frankl realised that his unique circumstances presented him an opportunity to explore the human response to suffering, based on actual experience rather than theory (Esping, 2010). Frankl observed that those prisoners who found meaning in their experience were those who were more likely to find the will to survive. Based on this understanding, Frankl's theory of Logotherapy is essentially meaning therapy, including fostering the will to find meaning, especially when circumstances include suffering and hardship. In this way, adversity may be perceived as not only deeply challenging and painful, but also as an opportunity to find meaning and growth (Frankl, 1959).

Frankl believed that potential for meaning exists in all circumstances and there is a fundamental human need, desire and motivation to search for and find it (Frankl, 1959). When we fail to find meaning, it creates a void within, which is felt as anxiety, depression, despair, confusion and the deeper experience of anomie (meaningless-ness) (Esping, 2010). Anomic depression occurs in response to an inability to experience or create meaning in life. Although it has different underlying origins to clinical depression, the symptoms are similar. It can arise due to inner psychological processes, but is often linked to socio cultural and interpersonal factors such as those experienced by refugees, the bereaved and the unemployed (Esping, 2011). Paradoxically, Frankl believed that this very sense of anomie - that one's life is meaningless - is evidence of how fundamental our need to find meaning is. The awareness of anomie becomes a felt need, which motivates the desire to find and create meaning in life (Frankl, 1959).

Meaning and the 'defiant power of the human spirit'
According to Frankl, life has inherent meaning which can be discovered in many different ways, unique to each individual. This contrasts with Freud's deterministic view, which proposes that we are motivated by instincts and drives. Frankl believed that the deeper, spiritual (in the broadest sense) part of the self contains a defiant power, that enables the self to rise above the influence of instincts, drives, environment and circumstances (Frankl, 1959). Frankl proposed three categories of meaning which originate in creative, experiential and attitudinal values:
 * 1) Creative values promote finding meaning through work, hobbies, commitment to a cause and other similar pursuits.
 * 2) Experiential values facilitate meaning making through nature, art and relationships.
 * 3) Attitudinal values are adaptive beliefs which develop in response to adversity. Frankl refers to these as defiant meanings, and proposes they emerge through the expression of courage in the face of tragedy (Frankl, 1959; Lantz, 1993).

An important feature of Frankl's theory is the balance between tension and happiness as a by-product of tension. Tension and suffering are part of human existence, however finding a balance between tension and happiness is not what brings about psychological well being - as if this were the case, only those with ideal lives would be mentally healthy. Rather, it is the ability to adjust to life as it is that eventually leads to happiness (Frankl, 1959; Gilbert, 2004) In the aftermath of trauma, a temporary loss of the sense of meaning in life often occurs (Janoff-Bulman, 2004). Yet this imbalance between life as it is and as it is desired to be causes the need for meaning to be felt more strongly, which in turn motivates the creation of new sources of meaning in life (Lantz, 1993).

Furthermore, Frankl proposes that happiness is a by-product of a meaningful life, so that happiness is not found when it is searched for directly. By replacing the search for happiness, with the search for meaning in life, happiness follows. Frankl suggests that self-transcendence and meaningful values are the ways that human happiness is found (Lantz, 1993). To a person who is suffering, and is acutely aware of the shortfall between their ideal and actual life experience, this offers the hope that happiness in life is eventually a possibility. As new meaning is found in life as it is, happiness gradually emerges, albeit in an altered form (Gilbert, 2004).

Dan Gilbert asks why are we happy? (TED talk, 20 mins)

How growth and benefits are measured
Three broad areas in which individuals report growth are self-perception, relationships with others, and philosophy of life. The Post-traumatic Growth Inventory (PTGI) is a widely used 21-item survey. It measures the degree to which growth has occurred in these domains after a difficult event (Cann et al., 2010). The five factors assessed by the PTGI items are: (Cann et al., 2010).
 * 1) Relating to others: deepening friendships, improved quality of relationships
 * 2) New possibilities: emotional growth and new opportunities arising from the adversity
 * 3) Personal strength: greater self reliance and competence
 * 4) Spiritual change: strengthened beliefs and increased sense of meaning
 * 5) Appreciation of life: changed priorities, enjoying life more, better perspective on life

Growth occurs as a combination of the relationships between the elements. For example, increased belief about ability to cope in one adverse situation can lead to greater belief in one's strength more generally (Tedeschi & Calhoun, 1996). Realisation of personal vulnerability can change priorities and result in greater use of social supports, which can have a flow on benefit of improving relationships with others (Janoff-Bulman, 2004).

A short version of the PTGI has been developed, which preserves the useful properties of the longer scale, but is less taxing for participants to use. Assessment of this instrument indicates that it has high internal reliability and correlations between the long and short forms (Cann et al., 2010). Possible responses range from
 * 1) not experiencing this change at all as a result of crisis
 * 2) experiencing change to a small degree as a result of crisis
 * 3) experiencing change to a moderate degree as a result of crisis
 * 4) experiencing change to a great degree as a result of crisis
 * 5) experiencing change to a very great degree as a result of crisis

The following table shows the questions in the short questionnaire, with the factors the item assesses in brackets.

Research on responses to traumatic events indicates that individuals tend to report both a sense of growth and depreciation, on the same dimensions (Harvey, Barnett, & Overstreet, 2004; Tomich & Helgeson, 2004). For example, a person may develop closer, more supportive relationships with some friends, while also finding that other friendships deteriorate. In this way, the individual experiences both growth and deficits on the dimension of friendship and social support. At first this seems contradictory, however this interplay of losses and gains is characteristic of the complex human response to difficulty (Tedeschi & Calhoun, 1996). Whilst the PTGI only allows for growth or loss to be reported for each domain, Baker et al., (2008) gave respondents the opportunity to report areas of both growth and depreciation in response to loss. Their findings confirmed that in response to the same difficulty, respondents were able to perceive both growth and loss, in the same domain. It is suggested this occurs as people keep separate 'scores' or judgements about outcomes, like an inner pros and cons list, and are able to hold simultaneously the two notions of growth and loss. This suggests that benefits and depreciation due to a crisis are independent measures (Baker et al., 2008).

How does growth occur?
Traumatic events fundamentally change assumptions about the world. Successful coping and adjusting to life after trauma does not mean that life returns to what it was previously. The event becomes a permanent part of the individual's psyche, through changes in personal basic schemas and fundamental assumptions about the world (Janof-Bulman, 2004). In the aftermath of crisis, a person faces immense expectancy disconfirmation, where what was believed to be true about the world has changed. Consequently, a new set of meaningful beliefs, or schemas, must gradually be created, that integrate a dual understanding of the experience that includes both disillusionment arising from the experience and an awareness of what has been gained through it (Janof-Bulman, 2004).

Strength through suffering
This growth area relates to the PTGI factors New Possibilities and Personal Strength. New Possibilities emerge in response to the development of new coping skills and personal resources as a result of overcoming adversity. These new possibilities may be obvious benefits such as greater belief in ability to cope or increased courage, or can also emerge due to limitations resulting from the trauma. For example, an athlete paralysed in an accident reported new enjoyment and deep satisfaction in academic pursuits that he had not previously known he was capable of (Janoff-Bulman, 2004).

Personal Strength is experienced in the aftermath of adversity, when an individual emerges with the realisation that they are stronger for the experience. As adjustment to the experience takes place, people often perceive themselves differently. As competencies and abilities are revealed, a new evaluation of the self is made. The self schema becomes one of a stronger, more capable person. A survivor of a debilitating accident reflected on his progress through the long-term adjustments he needed to make, with the commonly made response "I never knew I had it in me" (Janoff-Bulman, 2004).

From life without limbs, to life without limits
Nick Vujicic is an example of an individual who has found strength and meaning through suffering. Nick was born in 1982 in Brisbane, Australia, with no arms or legs. This presented extremely difficult circumstances for Nick and his parents. During adolescence, Nick experienced depression, bullying, self esteem issues and loneliness, as well as facing the day to day hardships of life without limbs. This was a time of questioning and searching for meaning in his suffering: Why was he different to the other kids? why did this happen, and happen to him? What was the purpose in his life? Did he even have a purpose?

Nick eventually found meaning in life and the answers to his questions through spirituality. He attributes his faith in God to helping him find the purpose for his existence and his difficult circumstances. This has helped him to rise above the challenges he faces and find a life that is rich with meaning and a sense of purpose. Nick has obtained a double degree from Griffith University, become a worldwide motivational speaker and is currently the President of an international organisation called Life Without Limits (Vujicic, 2011).

Youtube - Nick Vujicic

Rumination and resolution
One theory is that the growth process arises from the cognitive effort an individual makes as they seek to redefine core beliefs and rebuild the assumptive world after trauma (Calhoun & Tedeschi, 2006). It is further proposed that the greater the felt need to re-examine core beliefs, the higher likelihood that growth will occur (Cann et al., 2010). Core beliefs are ideas about how the world works based on experience, socialisation and learning. These beliefs are challenged by traumatic circumstances (Triplett, et. al, 2011). In response, individuals engage in cognitive effort to try and understand the event. One way this occurs is through rumination.

Rumination is ongoing thought that is focused on a particular topic. It is a common response to blocked goals, problems and failures (Ciarocco, et al., 2010). Rumination may be either intrusive or deliberate. Intrusive rumination involves automatic thoughts, memories and flash backs about the event, whereas deliberate rumination is intentionally thinking about the event with the goal of understanding it better. The two types of rumination have different qualities that differ in the ways they help to assimilate a traumatic experience into new core beliefs (Triplett et. al, 2011). Closer to the occurrence of the trauma, intrusive rumination helps facilitate the natural and necessary response of trying to comprehend what has happened. Once initial distress has diminished to some extent and some comprehension of the event has been gained, active processing of information through deliberate rumination may commence (Cann et al., 2011). Deliberate rumination is beneficial to coping at this stage, as it focuses on understanding the experience, finding meaning and generating a modified life narrative (Ciarocco et al., 2010; Tedeschi & Calhoun, 1996). This may eventually lead to integrating the event and its changed understanding of reality into a new set of core beliefs (Janoff-Bulmanm 2006). Rumination has been found to contribute significantly to the degree of resolution that individuals find in response to trauma (Anagnostopoulos, et al., 2010). However, resolution is a complex construct, with wide individual variance in what resolution means to individuals. There is a misconception that resolution means the event makes sense and is 'cleared away', however, personal changes that arise due to trauma are ongoing and enduring (Janoff-Bulman, 2006; Calhoun & Tedeschi, 2006).

Some individuals do not experience the need to find meaning or growth in response to loss. It is suggested this occurs because their perception of the situation does not cause the need for meaning to become a felt need, or they do not have the social, cognitive or emotional support to enable them to adapt to and make meaningful sense of their loss (Sandler, Wolchik, & Ayer, 2008).

For example, Davis, Wohl and Verberg (2007) studied individuals who had experienced unjust loss of a loved one due to a mine disaster. When interviewed 8 years later, 4 groupings of responses around meaning making and resolution emerged among the participants.
 * 1) One group consisted of those who had achieved some sense of resolution and meaning in the experience.
 * 2) A second group were still engaged in the search for meaning, but had not yet been able to reach a sense of resolution.
 * 3) A third group were those who were no longer dwelling on the loss, but had no sense of meaning.
 * 4) The final group were those who did not feel the need to assimilate the loss into their core beliefs or make sense of it.

This suggests individual differences in both the degree that loss threatens well-being and in the ability to adapt to loss (Sandler et al.,2008).

Benefit finding
Benefit finding is a widely occurring response to loss. It facilitates coping via a process of cognitive reappraisal, which finds the good in bad events (Sears, Stanton & Danoff-Burg, 2003). Survivors of heart attacks, cancer and spinal cord injury, women with fertility issues, stroke victims and parents of newborns in intensive care have reported benefits arising from their adverse experiences (Anagnostopoulos et al., 2010). Benefit finding is linked with improved psychological well-being, less negative mood, less depression, greater sense of meaning and better adjustment (Anagnostopoulos et al., 2010). It occurs partly through positive reappraisal, where events come to be perceived as meaningful, by being more orderly, predictable and controllable. This supports well-being by restoring damaged self-identity and reducing the sense of victimisation that occurs through traumatic events (Sears, et al., 2003) and integrating the experience into an individual's belief system (Newman, Riggs & Roth, 1997). Although benefit finding is associated with emotional well-being, variance in perceived positive outcomes of adversity may be influenced partly by personality differences. The five major dimensions of personality on the Five Factor Model indicate that individuals high on extroversion are more likely to use coping strategies such as positive thinking, rational action and substitution, whereas those high on openness tend to use humour. Passive and withdrawn behaviour is a more likely response from those higher on the dimension of neuroticism (Wilson & Boden, 2008). Furthermore, it is not recommended that individuals experiencing suffering be required to find benefits as a form of intervention, but rather that the process is supported if it occurs naturally (Sears et al., 2003).

Conclusion
Lance Armstrong articulates how adversity such as cancer can be the basis upon which new meaning in life is found. Armstrong is realistic in his description of meaning making as a gruelling process that does not occur without struggle, yet he is profoundly hopeful and illustrates why meaning matters if growth is to occur out of adversity:

""Put aside your ideas about heroes and miracles, because I'm not storybook material... I've read that I flew up the hills and mountains of France. But you don't fly up a hill. You struggle slowly and painfully up a hill, and maybe, if you work very hard, you get to the top ahead of everybody else.

Cancer is like that, too. Good, strong people get cancer, and they do all the right things to beat it, and they still die. That is the essential truth that you learn. People die. And after you learn it, all other matters seem irrelevant. They just seem small.

My illness was humbling and starkly revealing, and it forced me to survey my life with an unforgiving eye. There are some shameful episodes in it: instances of meanness, unfinished tasks, weakness, and regrets. I had to ask myself, "If I live, who is it that I intend to be?" I found that I had a lot of growing to do as a man." (Armstrong & Jenkins, 2000)"

The robust sense of personal meaning and the ability to find meaning in life exemplified by Armstrong are associated with greater well-being and lower psychological distress for individuals facing adversity. Meaning making is a significant factor in lessening the impact of negative thoughts and facilitating adjustment. This may be because those who have a strong belief that life has purpose may engage more actively in cognitive restructuring, benefit finding, identifying strengths and integrating the event into a new self-schema through rumination. Effective coping efforts are not directed towards the event, which cannot be changed, but towards rebuilding a threatened self-concept through revision of life goals and reordering of priorities (Anagnostopoulos et al., 2010).