adversity and psychological well being by durkin and joseph=

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Growth Following Adversity and ItsRelation with Subjective Well-Beingand Psychological Well-Being

JOHN DURKIN and STEPHEN JOSEPHCentre for Trauma, Resilience, and Growth, University of Nottingham,

Nottingham, United Kingdom

Studies have shown that posttraumatic growth is associated with greater well-being. However, it is not clear whether posttraumatic growth is related to subjective well-being (SWB) or psychological well-being (PWB). Whereas SWB is derived from the hedonistic tra-dition, PWB is derived from the eudaimonic tradition. In a sample of 125 college students who had experienced a distressing event, we found evidence that growth is related to PWB rather than SWB.

It is now understood that while traumatic events can have severe and chronicpsychological effects, for many people the struggle with adversity also leadsto posttraumatic growth. Posttraumatic growth has been documented in a variety of populations following accidents, illnesses, and disasters, and isknown to be associated with various cognitive and social factors (see Linley & Joseph, 2004). One area that has yet to be investigated is the associationbetween posttraumatic growth and well-being, and in particular whethergrowth is associated with subjective well-being (SWB) or psychological well-being (PWB).

There are important conceptual differences between SWB and PWB. Whereas SWB refers to affective states coupled with life satisfaction, PWBrefers to existential engagement with life, purpose, autonomy, and mastery.However, measurement within the growth literature has sometimes con-flated these concepts; for example, Frazier and Kaler (2006, Study 2)

Received 27 May 2008; accepted 1 July 2008. Address correspondence to John Durkin, Centre for Trauma, Resilience, and Growth,

School of Sociology and Social Policy, University Park, Nottingham NG7 2RD, United

Kingdom. E-mail: [email protected]

Journal of Loss and Trauma , 14:228234, 2009Copyright # Taylor & Francis Group, LLCISSN: 1532-5024 print=1532-5032 onlineDOI: 10.1080/15325020802540561

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described life appreciation as a domain of growth and measured it as acombination of satisfaction with life, a component of SWB, and gratitude,a disposition associated with PWB. Furthermore, sometimes the termsSWB and PWB have been used interchangeably. Abraid oo-Lanza, Guier,

and Coloon (1998), for example, measured positive and negative affect,components of SWB, but referred to them as psychological well-being.Thus, although their study might be taken to provide evidence for the rela-tionship between growth and PWB, their results actually reflect hedonicresponses rather than the eudaimonic responses to which Ryffs (1989) con-cept of PWB refers.

Although several studies have now found posttraumatic growth to beassociated with SWBthat is, higher positive affect (Abraid oo-Lanza et al.,1998; Evers et al., 2001; Park, Cohen, & Murch, 1996) and lower negativeaffect (Abraido-Lanza et al., 1998; Evers et al., 2001)the concept of post-

traumatic growth is derived from the eudaimonic tradition of psychology rather than the hedonistic tradition (Joseph & Linley, 2005). SWB is derivedfrom the hedonistic tradition, whereas PWB is derived from the eudaimonictradition (Keyes, Shmotkin, & Ryff, 2002). Consequently, while it would seemthat growth is related to SWB, it is not certain that growth is related to PWB,although it might be suggested that posttraumatic growth would be expectedto be more strongly related to PWB than to SWB. The aim of this study is tobring some clarity to the mixed findings on growth and well-being by testingfor the association between growth and both SWB and PWB.

METHOD

Participants and Procedure

Questionnaire batteries were distributed to 300 university students duringprivate study, of which 246 were returned completed. Participants were143 women (58 % ) and 103 men (42 % ) with a mean age of 20.6 years(SD 2.6), and all spoke English as their native language. Of these 246participants, most reported experiencing a negative life event in the pre- vious year, of whom 125 scored at or above 35 on the Impact of EventScale, which is often used a cutoff indicative of significant psychologicaldistress following a traumatic event (Joseph, 2000). Subsequent analyses were conducted on these 125 (51 % ) individuals in order to ensure thatour sample contained those most likely to have met the elevated levelof event-related distress that has been argued to initiate posttraumaticgrowth processes (Tedeschi & Calhoun, 1995). This final group included81 women (65 % ) and 44 men (35 % ) with a mean age of 20.4 years(SD 1.78), 91% were single.

The most commonly reported events were the loss of a relative or friend

through death (22.3 % ), followed by termination of a romantic relationship

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(17.9% ), problems with relationships (16.1 % ), interpersonal conflicts(13.4% ), career difficulties (9.8 % ), becoming victims of violence or accidents(9.8% ), learning of others illnesses (3.6 % ), causing self-inflicted injuries(2.7% ), and various other incidents (4.5 % ). The time elapsed since the event

was between 0 and 140 months ( M

16.3, SD

21.3).

Measures

POSITIVE AND NEGATIVE AFFECT SCHEDULE

The Positive and Negative Affect Schedule (PANAS, Watson, Clark, & Telle-gen, 1988) is a 20-item self-report scale that measures positive and negativedimensions of mood within a given time period. It is scored according to a5-point Likert-format scale (1 very slightly or not at all, 5 extremely ).

The PANAS comprises two subscales: Positive Affect (10 items; e.g., inter-ested, alert, excited score range 1050) and Negative Affect (10 items;e.g., irritable, distressed, ashamed score range 1050) with higherscores indicating greater positive and negative mood, respectively.

S ATISFACTION WITH LIFE SCALE

The Satisfaction with Life Scale (SWLS, Diener, Emmons, Larsen, & Griffin,1985) is a five-item self-report scale measuring life satisfaction as judged by the participant. It is scored on a 7-point Likert-format scale ranging from 1( strongly disagree) to 7 ( strongly agree) . Sample items include In most ways my life is close to ideal and If I could live my life over, I would change almost nothing . The score range is 535, with higher scores indicatinggreater satisfaction with life.

PSYCHOLOGICAL WELL-BEING SCALES

The Psychological Well-Being Scales (PWBS; Ryff, 1989) comprise sixsubscales: Autonomy (e.g., I have confidence in my opinions, even if they are contrary to the general consensus ), Environmental Mastery (e.g., I amquite good at managing the many responsibilities of my daily life ),Personal Growth (e.g., I am not interested in activities that will expand my horizons reverse scored), Positive Relations with Others (e.g., I enjoy personal and mutual conversations with family members or friends ),Purpose in Life (e.g., I enjoy making plans for the future and working to make them a reality ), and Self-Acceptance (e.g., I like most aspects of my personality ). Responses to the items are made on a 1 (strongly dis-agree) to 6 (strongly agree) scale. In the present study, nine-item subscales were used and only the total PWB score was reported, with higher scores

indicating greater psychological well-being.

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IMPACT OF EVENT SCALE

The Impact of Event Scale (IES; Horowitz, Wilner, & Alvarez, 1979) is a 15-item self-report measure of the frequency with which intrusions and avoid-ance are experienced in the aftermath of a distressing event. The IES usesa 4-point Likert-format scale (0 not at all, 1 rarely, 3 sometimes ,5 often ) to record how true each statement was for the participant duringthe past week. Higher scores indicate greater levels of intrusions and avoid-ance. The IES is one of the most widely used instruments in research onstress and trauma, with good psychometric properties (Joseph, 2000).

CHANGES IN OUTLOOK QUESTIONNAIRE

The Changes in Outlook Questionnaire (CiOQ; Joseph et al., 1993) is a 26-item self-report measure. It records changes in outlook in response to a focalevent that was previously identified as subjectively stressful. It is scoredaccording to a 6-point Likert-format scale (1 strongly disagree, 6 strongly strongly agree ). The CiOQ comprises two subscales: Positive Changes (CiOP;11 items; e.g., I value my relationships much more now and I look uponeach day as a bonus score range 11 66) and Negative Changes (CiON;15 items; e.g., I dont look forward to the future anymore and I have very little trust in other people now score range 15 90) with higher scoresindicating greater positive and negative changes, respectively. In the presentstudy, only scores on the CiOP were used.

POSTTRAUMATIC GROWTH INVENTORY

The Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) is a21-item self-report measure. It records responses to positive outcomes to afocal event that was previously identified as subjectively stressful. It is scoredaccording to a 6-point Likert-format scale (0 I did not change as a result of the event I described, 5 I changed to a very great degree as a result of the event I described ). Sample items include I established a new path for my life, Appreciating each day, and New opportunities are available that

wouldnt have been otherwise. Subscales are Relating to Others, New Possi-bilities, Appreciation for Life, Spiritual Change , and Personal Strength . Theoverall score range is 0 105, with higher scores indicating greater posttrau-matic growth.

RESULTS

Higher scores on the PTGI were associated with higher scores on the PWBscale. Also higher scores on the CiOP were associated with higher scores

on positive affect and higher scores on the PWB scale (see Table 1).



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As CiOP was associated with both positive affect and PWB, partial cor-relations were conducted to test for unique effects. With PWB partialed out,the association with positive affect was no longer statistically significant( pr .08, ns), but with positive affect partialed out, the association withPWB remained statistically significant ( pr .21, p < .01).

DISCUSSION

Progress toward an understanding of the processes underlying growth fol-lowing adversity has been constrained by conceptual uncertainties, includingthe relationship with well-being (Park & Helgeson, 2006). This is the firststudy to present empirical evidence that growth following adversity is relatedto PWB over and above SWB, supporting the theoretical position that growthcan be regarded as a developmental process of self-motivated engagementrather than a restorative process of emotion regulation and symptommanagement.

However, although little support was found for the association withhedonic aspects of well-being this does not necessarily negate the contribu-

tion that positive emotions may make to growth. Positive emotions havebeen shown to facilitate problem solving (Isen, Daubman, & Nowicki,1987) and enhance cognitive responses and actions toward discovering posi-tive meaning (Fredrickson, 2001). Such suggestive links between SWB andPWB may be of value in attempting to identify the processes involved ingrowth but await more sophisticated methods to unearth the direction andmagnitude of any relationships.

There are clinical implications to be drawn from this study. In general,intervention strategies are either developed to target SWB or PWB. Approaches that target SWB may not tap processes that underlie PWB

sufficiently, and traditional approaches to clinical work may therefore be

TABLE 1 Descriptive Statistics for Study Variables and Correlations With Growth Measures.

Mean Observed(SD) range CiOP ( r ) PTGI (r )

PANAS Positive Affect 31.84 (6.72) 1348 .18 .15PANAS Negative Affect 23.27 (6.77) 1139 .04 .12SWLS 22.37 (5.91) 834 .12 .08PWBS 233.12 (27.73) 158305 .26 .20CiOP 43.20 (8.40) 2060 .67PTGI 50.36 (19.40) 0105

Note. PANAS Positive and Negative Affect Schedule; SWLS Satisfaction with Life Scale; PWBS Psychological Well-Being Scales (9-item); CiOP Positive changes subscale of Changes in OutlookQuestionnaire; PTGI Posttraumatic Growth Inventory. p < .05; p < .01; p < .001.



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ineffective in promoting growth. For this reason, what we know about thealleviation of posttraumatic stress may not generalize to the facilitation of posttraumatic growth.

Although the use of a university student sample is a limitation, the use of

the IES to select only those experiencing a significant level of distress sug-gests that these results may generalize to clinically relevant populations.Some caution is indicated, however, with respect to our sample self-selectingfor high distress, insofar as 51 % of those who were recruited to take part inthe study scored above 35 on the IES. Also, because this was a correlationalstudy, causality cannot be inferred, and it is likely that over time there is acomplex relationship between SWB and PWB. We would suggest that inthe longer term PWB is likely to lead to increases in SWB.

REFERENCES

Abraidoo-Lanza, A. F., Guier, C., & Coloon, R. M. (1998). Psychological thriving amongLatinas with chronic illness. Journal of Social Issues , 54 , 405424.

Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With LifeScale. Journal of Personality Assessment , 49 , 7175.

Evers, A. W. M., Kraaimaat, F. W., van Lankveld, W., Jongen, P. J. H., Jacobs, J. W. G.,& Bijlsma, J. W. J. (2001). Beyond unfavorable thinking: The Illness CognitionsQuestionnaire for chronic diseases. Journal of Consulting and Clinical Psychol-ogy , 69 , 10261036.

Frazier, P. A., & Kaler, M. E. (2006). Assessing the validity of self-reported

stress-related growth. Journal of Consulting and Clinical Psychology , 74 ,859869.

Fredrickson, B. L. (2001). The role of positive emotions in positive psychology. American Psychologist , 56 , 218226.

Horowitz, M., Wilner, N. J., & Alvarez, W. (1979). Impact of Event Scale: A measureof subjective stress. Psychosomatic Medicine , 41 , 209218.

Isen, A. M., Daubman, K. A., & Nowicki, G. P. (1987). Positive affect facilitatescreative problem solving. Journal of Personality and Social Psychology , 52 ,11221131.

Joseph, S. (2000). Psychometric evaluation of Horowitzs impact of event scale: A review. Journal of Traumatic Stress , 13 , 101113.

Joseph, S., and Linley, P. A. (2005). Positive adjustment to threatening events: Anorganismic valuing theory of growth through adversity. Review of General Psychology , 9 , 262280.

Joseph, S., Williams, R., & Yule, W. (1993). Changes in outlook following disaster:The preliminary development of a measure to assess positive and negativeresponses. Journal of Traumatic Stress , 6 , 271279.

Keyes, C. L. M., Shmotkin, D., & Ryff, C. D. (2002). Optimizing well-being: Theempirical encounter of two traditions. Journal of Personality and Social Psychology , 82 , 10071022.

Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A

review. Journal of Traumatic Stress , 17 , 1121.



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Park, C. L., Cohen, L. H., & Murch, R. (1996). Assessment and prediction of stress-related growth. Journal of Personality , 64 , 71105.

Park, C. L., and Helgeson, V. S. (2006). Introduction to the special section: Growthfollowing highly stressful life eventscurrent status and future directions. Journal of Consulting and Clinical Psychology , 74 , 791796.

Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology , 57 ,10691081.

Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing inthe aftermath of suffering. Thousand Oaks, CA: Sage.

Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Mea-suring the positive legacy of trauma. Journal of Traumatic Stress , 9 , 455471.

Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Person-ality and Social Psychology , 54 , 10631070.

John Durkin is a PhD student in the School of Sociology and Social Policy at theUniversity of Nottingham.

Stephen Joseph is a professor of psychology, health and social care at the University of Nottingham, where he is co-director of the Centre for Trauma, Resilience, andGrowth and an Honorary consultant psychologist in Nottinghamshire NHS HealthcareTrust.



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