The two sides of posttraumatic growth : a study of the Janus Face Model in a college population

Transcription

1 The University of Toledo The University of Toledo Digital Repository Theses and Dissertations 2010 The two sides of posttraumatic growth : a study of the Janus Face Model in a college population Darren R. Jones The University of Toledo Follow this and additional works at: Recommended Citation Jones, Darren R., "The two sides of posttraumatic growth : a study of the Janus Face Model in a college population" (2010). Theses and Dissertations This Dissertation is brought to you for free and open access by The University of Toledo Digital Repository. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of The University of Toledo Digital Repository. For more information, please see the repository's About page.

2 A Dissertation entitled The Two Sides of Posttraumatic Growth: A Study of the Janus Face Model In a College Population by Darren R. Jones, M.A. Submitted to the Graduate Faculty as partial fulfillment of the requirement for The Doctor of Philosophy in Psychology Committee Chair: Mojisola F. Tiamiyu, Ph.D. Committee member: Wesley A. Bullock, Ph.D. Committee member: Jeanne H. Brockmyer, Ph.D. Committee member: Alice Skeens, Ph.D. Committee member: Janis Woodworth, Ph.D. Dr. Patricia Komuniecki, Dean, College of Graduate Studies The University of Toledo August 2010

3 Copyright 2010, Darren R. Jones This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author.

4 An Abstract of Darren R. Jones Submitted to the Graduate Faculty as partial fulfillment of the requirements for The Doctor of Philosophy Degree in Psychology The University of Toledo August 2010 The concept that people can have positive changes as a result of dealing with adversity is an ancient concept. In contrast, Posttraumatic Growth is a relatively recent addition to our understanding of people s response to life s struggles. Posttraumatic Growth (PTG) is conceptualized as positive changes in a person s life that they attribute to having faced a traumatic and/or stressful event. However, PTG research is still in its youth and there are several major unanswered questions about the construct and its utility. Part of this is due to conflicting findings related to the relationship between PTG and psychological distress and adaptive significance. The Janus Face Model of PTG is a theory that attempts to unify the competing theories and findings into a cohesive whole. This study examined possible support for the Janus Face Model in a college population. In addition, the study investigated the rates of reported trauma experiences and levels of posttraumatic growth in relation to those events. Results indicated that there was only weak support for the Janus Model in the sample. In general, participants reported small to large amounts of positive growth related to their stated traumatic or stressful event. Notably, a small minority of participant s reported negative growth related to their experience. The results suggest that participants experienced PTG in relation to a wide range of events, with bereavement being the predominant reported traumatic event. iii

5 Acknowledgements I would like to thank the following people for their support and input throughout the dissertation process. First, I wish to acknowledge my chair and advisor, Dr. Tiamiyu, who has been a strong supporter of this project since it began. Her enthusiasm and guidance played an important role in the completion of this dissertation. Second, I wish to thank Dr. Brockmyer, whose input was invaluable throughout the writing process. Third, I want to thank the other members of the committee, Drs. Bullock, Skeens, and Woodworth, for their assistance and support. I would also like to thank the treasures of my life, my wife Ann, our son Jacob, and our daughter Sophie. Their love and patience inspired and sustained me throughout the entire dissertation process. iv

6 Contents Abstract.. iii Acknowledgements iv Table of Contents v List of Tables. vii List of Appendices.. viii Chapter 1: Introduction 1 Chapter 2: Literature Review.. 5 Definitions Negative Effects of Trauma.. 6 Posttraumatic Growth 9 Posttraumatic Growth Model.. 10 Posttraumatic Growth in Children. 16 Assessment of Posttraumatic Growth 18 Previous Research on Posttraumatic Growth.. 21 Unresolved Issues in Posttraumatic Growth.. 28 Janus Face Model of Posttraumatic Growth. 30 Statement of the Problem 32 Exploratory Research Questions.33 Chapter 3: Method. 35 Participants. 35 v

7 Procedure Measures. 38 Trauma Events Inventory (TEI). 38 Purdue Posttraumatic Stress Scale-Revised (PPTS-R) Stress-Related Growth Scale-Revised (SRGS-R).. 39 Illusory and Constructive Scales 40 Chapter 4: Results. 42 Participants. 42 Preliminary Analysis.. 42 Total Scores 43 Stress-Related Growth Scale-Revised (SSRGS-R) Scores 43 International Personality Item Pool (IPIP) Scores. 47 Bivariate Correlations. 52 Rates by Reported Trauma.. 54 Traumatic Events Inventory (TEI) Scores Purdue Posttraumatic Stress Scale-Revised (PPTS-R) Scores 58 Primary Analysis. 60 Regression 60 Chapter 5: Discussion 67 Limitations..73 Clinical Implications..74 Research Implications 76 Future Directions...77 vi

8 References..79 vii

9 List of Tables Table 1. DSM-IV Posttraumatic Growth Disorder Diagnostic Criteria..8 Table 2. Item Means for Stress-Related Growth Scale-Revised: Full Scale. 44 Table 3. Stress-Related Growth Scale-Revised: Scale Scores for Overall Sample...46 Table 4. International Personality Item Pool Item Scores. 48 Table 5. The International Personality item Pool Scale Scores. 51 Table 6. Bivariate Correlations Between Major Study Variables.. 52 Table 7. Response Rates for Potentially Trauma Events on the Traumatic Events Inventory (TEI).. 55 Table 8. Reported Focal Trauma Events...56 Table 9. Item Means on the Purdue Posttraumatic Stress Scale Revised...58 Table 10. Predictors of Time Elapsed Since Trauma Event.. 61 Table 11. Predictors of Purdue Posttraumatic Stress Scale-Revised Distress Scores...62 Table 12. Predictors of Full Scale Stress-Related Growth Scale-Revised Scores Table 13. Predictors of Capacity For Love Scale Scores Table 14. Predictors of Resourcefulness Scale Scores.. 65 Table 15. Predictors of Wisdom Scale Scores...66 viii

10 List of Appendices Appendix A. Informed Consent Form.. 86 Appendix B. Trauma Debriefing Information Sheet Appendix C. Traumatic Events Inventory (TEI)..90 Appendix D. Purdue Posttraumatic Stress Scale-Revised (PPTS-R).95 Appendix E. Stress-Related Growth Scale-Revised (SRGS-R) 97 Appendix F. International Personality Item Pool Measures (IPIP)...99 Appendix G. Complete Study Protocol Appendix H. Stress-Related Growth Scale-Revised Scale Scores by Trauma Event 121 Appendix I. International Personality Item Pool Scale Scores by Focal Event Type 125 Appendix J. Trauma Distress Scores by Focal Trauma Events ix

11 Chapter One Introduction What does not destroy me, makes me stronger. Friedrich Nietzsche (Nietzsche, 1990, p. 33) This oft-quoted line from Nietzsche distills the central notion that will be explored in this study. This study examines the idea that people can not only survive adversity, but can perhaps experience growth as a result of dealing with life s struggles. More specifically, this study endeavors to investigate aspects of this phenomenon that remain unclear. The topic of trauma has been prominent in both popular culture and academic circles for the past 30 years (Shephard, 2000). In particular, posttraumatic stress disorder (PTSD) has garnered a great deal of interest since its addition to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 (American Psychiatric Association, 1980). In general, the focus on trauma has revolved around the negative effects of exposure to traumatic events. This is both understandable and intuitive. There are many well-documented adverse effects that trauma exposure can potentially have on people. However, some theorists argue that there may be positive effects of trauma exposure, as well. These positive consequences, while not receiving nearly as much attention as the negative effects, have begun to recently garner interest from the research community.

12 The idea that people can experience positive changes related to adversity in their lives is hardly new (Calhoun & Tedeschi, 2006). There is ample evidence going far back in history that indicates that this concept has been part of the human psyche since ancient times. There are numerous notable examples of this phenomenon, with those from the world of religion being perhaps the most influential. The themes of attempting to understand suffering and persevere through it, plays a major role in Christianity, wherein the tortures that Jesus endured are given transcendent symbolic value to its adherents. There are also examples from Islam, Buddhism, and other influential religious movements. These ideas are also well-represented in literature, both in high-brow and popular contexts (Zoellner & Maercker, 2006). Though these ideas are clearly quite old, the topic s appeal to researchers is a significantly more recent development (Calhoun & Tedeschi, 2006). Though many terms have been used to describe the construct, perhaps the most widely used term is posttraumatic growth (PTG). Posttraumatic growth has been defined as positive change that the individual experiences as a result of the struggle with a traumatic event (Calhoun & Tedeschi, 1999, p. 11). Researchers have identified three main areas in which people generally report PTG in their lives. These areas consist of their relationships with others, their sense of self, and their philosophy of life. Though scholarship in the area of PTG has increased markedly in the previous decade, many basic questions remain. Among the important questions regarding PTG is whether it represents mainly a positive cognitive perspective regarding the traumatic event or if it translates to substantial, observable behavioral changes in the person s life (Zoellner & Maercker, 2006). Theorists are divided on this issue. Also, it is unclear if PTG is related to 2

13 adjustment. We would expect that positive changes would be reflected in more adaptive functioning among trauma survivors (Westphal & Bonanno, 2007). Currently, there are conflicting research findings on this important point (Zoellner & Maercker, 2006). Another issue that needs to be addressed is whether there is a dose-response effect with PTG. In other words, does the severity of the trauma positively correlate with larger amounts of PTG? In order to maximize the benefit of PTG for people, these key issues will need to be better understood. There are a variety of implications and applications for PTG (Calhoun & Tedeschi, 1999). First, it is beneficial for therapists to help their clients identify and maximize any positive impact that adverse life experiences may have had on them. This approach is at odds with traditional techniques that often focus exclusively on the pathological elements of trauma. Second, PTG can be incorporated into existing trauma treatments. It is not necessary to deviate from already empirically-supported trauma treatments, such as prolonged exposure therapy. Rather, PTG therapy work can be a valuable adjunct to these treatments, which may lead to improved outcomes. Third, increased research in PTG will add to our still-evolving understanding of the impact of trauma. This is particularly relevant at this time, in which the impending publication of the fifth edition of the DSM will perhaps modify our diagnostic approach to PTSD for years to come. For example, there are those in the trauma field who argue that a dimensional approach to PTSD would be preferable to our current dichotomous diagnostic criteria (McNally, 2004). However, there are still many aspects of PTG that are unclear (Zoellner & Maercker, 2006). First, there is a debate among researchers in the field as to whether PTG 3

14 is a coping strategy or an outcome (Hobfoll, et al., 2007). Second, researchers have reported conflicting findings on the relationship between PTG and psychological distress, in particular PTSD-related symptoms. Some argue that the construct and utility of PTG is called into question when those reporting growth are not showing corresponding levels of reduction in distress (Hobfoll, et al., 2007). Third, the bulk of the research has focused almost exclusively on the possible constructive aspects of PTG, while largely ignoring the potential for less adaptive manifestations. This oversight has contributed to the theoretical questions surrounding the PTG construct. The chief goal of this study was to examine a theory of PTG that attempts to reconcile these contradictory research issues. As conceptualized by Zoellner and Maercker (2006) in their Janus-Face model, PTG consists of two cognitive components, one constructive and the other illusory. Specifically, the Janus-Face model recognizes a self-deceptive aspect of PTG, while also acknowledging a functional component. If support is found for this theory through research, it could provide an important framework that is currently lacking in our understanding of PTG. First, the past literature on PTG research will be reviewed. Second, the methods of the study will be reviewed, including a discussion of participants, procedures, measures, and analysis. Third, the results will be presented and explored. Finally, the findings will be discussed. This will include a discussion of the significance and limitations of the study, clinical and research implications, and future directions. 4

15 Chapter Two Literature Review Definitions A discussion about the impact of trauma must first address the question; what constitutes a traumatic event? Based on the DSM-IV diagnostic criteria for PTSD, an extreme traumatic stressor involves dir ect personal experience of an event that involves actual or threatened death or serious injury, or other threat to one s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (APA, 2000, p. 463). This definition of a traumatic event takes into account a variety of incidents, including, but not limited to, combat, sexual assault and other violent crimes, serious car accidents, and the diagnosis of a fatal disease, such as cancer (APA, 2000). It should be noted that the trauma event criteria were made more inclusive with the publication of DSM-IV. In contrast, DSM-III required that the trauma event be an experience that is uncommon for most people, which could be interpreted to exclude a number of the aforementioned events that are currently acceptable to meet the stressor criteria. The DSM-III criteria were developed primarily with combat exposure in mind, therefore common societal events such as sexual assault and automobile accidents were not a central focus (McNally, 2004). 5

16 Theorists studying PTG generally take a broader and more subjective view of what constitutes a trauma event. Tedeschi and Calhoun (2004) favor a more inclusive definition of trauma that they describe as lifecrisis. While they include the more serious types of events that are mentioned in the DSM-IV PTSD criteria, they also include events that may be viewed as of a less fatal nature, such as dealing with a nonlethal, yet debilitating, medical condition, such as rheumatoid arthritis. Calhoun and Tedeschi (1999) conceptualize PTG as resulting from seismic events, which are those incidents that have a profound impact on the person s worldview and emotional functioning. It should be noted that PTG is not dependent on meeting the diagnostic criteria for PTSD, however, it is likely that many people who report PTG have met the PTSD criteria at some point. A critical difference between PTG and traditional approaches to trauma is the focus on strens, which are experiences that bolster a persons psychological functioning (Tedeschi & Kilmer, 2005). This emphasis on salutogenesis, the processes that are associated with healthier outcomes, is in contrast to the conventional trauma practices, which are geared toward pathogenesis processes. This focus on salutogenesis is not the province of PTG exclusively, however. Theorists that study similar constructs, such as resilience also work from this perspective (Tedeschi & Calhoun, 2005). Negative Effects of Trauma The negative effects of trauma have been well-researched and they form the basis for most trauma-related treatments today (Calhoun & Tedeschi, 1999). First, the experience of a traumatic event leads to a heightened risk of developing psychiatric disorders, most notably PTSD. See Table 1 for the complete DSM-IV diagnostic criteria 6

17 for PTSD. The PTSD diagnostic criteria include three main aspects: a reexperiencing of the event through thoughts, images, or perceptions; a persistent avoidance of the stimuli associated with the event and numbing of general responsiveness; and persistent symptoms of hyperarousal, such as difficulty sleeping, irritability, hypervigilance, or concentration problems. For PTSD diagnostic criteria to be met, at least one month must have elapsed since the event took place. If less than one month has passed since the event, and the other diagnostic criteria are met, a diagnosis of acute stress disorder (ASD) is given. In addition to developing ASD or PTSD, trauma exposure makes people more vulnerable to other disorders, as well. In particular, depression and substance abuse are common comorbid disorders among people with an ASD or PTSD diagnosis (APA, 2000). A second potential negative outcome of trauma exposure is distressing emotions and/or thoughts (Calhoun & Tedeschi, 1999). There is variability in the types of emotional reactions and thoughts that trauma survivors experience. This variance is due, at least in part, to individual differences, and the severity and type of trauma event experienced. However, common emotional reactions include anxiety, fear, sadness, guilt, anger, and irritability. Common distressing thoughts include shock, disbelief, and numbness. One common trauma reaction, especially among those who have PTSD, is intrusive thoughts that permeate the consciousness of the individual. These intrusive thoughts often appear even as the individual is attempting to avoid thinking about the event. 7

18 Table 1: DSM-IV Diagnostic Criteria for Posttraumatic Stress Disorder (PTSD) (American Psychiatric Association, 2000, p ) A. The person has been exposed to a traumatic event in which both of the following were present: 1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others 2) the person s response involved intense fear, helplessness, or horror B. The traumatic event is persistently reexperienced in one (or more) of the following ways: 1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions 2) recurrent distressing dreams of the event 3) acting or feeling as if the traumatic event were recurring 4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: 1) efforts to avoid thoughts, feelings, or conversations associated with the trauma 2) efforts to avoid activities, places, or people that arouse recollections of the trauma 3) inability to recall an important aspect of the trauma 4) markedly diminished interest or participation in significant activities 5) feeling of detachment or estrangement from others 6) restricted range of affect 7) sense of foreshortened future D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: 1) difficulty falling or staying asleep 2) irritability or outbursts of anger 3) difficulty concentrating 4) hypervigilance 5) exaggerated startle response E. Duration of the disturbance is more than 1 month F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning 8

19 Another negative outcome related to trauma exposure is problematic behaviors (Calhoun & Tedeschi, 1999). In particular, the attempts to avoid reminders of the trauma event often lead to social isolation and the use of alcohol and drugs among trauma survivors. Another possible behavior problem is aggression. Some trauma survivors, especially those who have been physically or sexually abused in childhood, are at a higher risk for impulsive, aggressive behaviors. This is especially true when the individual is using excessive amounts of alcohol. Finally, some people exposed to trauma experience distressing physical reactions (Tedeschi & Calhoun, 1999). Due in part to the overactivity of the body s stress response system, trauma survivors may experience a range of physical complaints, such as feeling fidgety, tense, lethargic, gastrointestinal problems, and having breathing difficulties. Posttraumatic Growth Tedeschi and Calhoun (2004) posit that a number of positive effects of trauma exposure take place in some people. They suggest that people who experience PTG, generally report growth in three areas: a changed sense of relationship with others, changed sense of self (feeling more vulnerable, yet stronger), and changes in life philosophy. In the area of a changed sense of relationships with others people report feeling an increase in intimacy and closeness with their loved ones (Tedeschi & Calhoun, 2004). This is an especially notable phenomenon since trauma reactions can have a detrimental impact on a person s relationships. Furthermore, individuals with improved relationships often report feeling more open to self-disclosure. Also, people reporting PTG may 9

20 experience an increase in empathy and compassion towards those that are dealing with adversity themselves. Another major change in PTG is a changed sense of self that includes feeling increased vulnerability, but also feeling stronger at the same time (Tedeschi & Calhoun, 2006). On its face, these may seem to be incongruent concepts. However, some people report that their traumatic event illustrated to them that they are not impervious to harm and that this serves as a corrective experience, in that, they are less likely to take unnecessary risks. At the same time, they report feeling stronger at having lived through the event and, though it has been a struggle, they are better able to handle future setbacks or adversity. The third major area of growth is in the area of changed philosophy of life (Tedeschi & Calhoun, 2006). In this aspect of PTG, people report a greater appreciation of their life. This often leads to the person reconsidering the priorities in their life. For example, some people alter their schedule in order to focus less time on their work and more on their families. Another common experience in PTG is an increased pleasure in the everyday experience s of life that previously may have been unnoticed or taken for granted. Religious and spiritual beliefs are also sometimes strengthened by traumatic experiences. Adversity has been viewed by some as creating a thin place, a celtic mythological term describing situations in which it is more likely to experience supernatural phenomenon (Tedeschi & Calhoun, 2006). Posttraumatic Growth Model Tedeschi and Calhoun (2004) have outlined a theory as to how PTG occurs. Figure 1 illustrates the basic components of PTG. The authors stress that PTG is not a 10

21 direct result of the trauma event. Rather, PTG results from the person s struggle with the impact of the event on their worldview. This struggle includes challenges to the individual s sense of understanding, decision-making, and meaning regarding their life and the world around them. Tedeschi and Calhoun posit that this struggle is akin to rebuilding a city after an earthquake, in which the person is attempting to reconstruct their cognitive world after a seismic event. At the beginning of the Tedeschi and Calhoun PTG schematic is the individual in their pretrauma existence. This, of course, includes the person s current resources, both strengths and weaknesses regarding coping with stressors. Next, is the seismic trauma event itself. The event leads to a variety of challenges for the individual. First, the person must manage their emotional distress. This may include a variety of reactions, including anxiety and mood-related symptoms. A second challenge is to the person s beliefs and goals. Here, the individual s sense of themselves and the world around them are under strain from the fallout of the event. Third, the narrative of a person s life, a detailed script of their personal history, presents a challenge, as well. Often, a traumatic event splits a person s life story into a before and after mindset. It is important for the person to develop a life narrative of the event that takes into account both their pre and post trauma event selves. Some theorists believe that this is vital in order for the person to be able to incorporate the trauma into their life story and make it possible for them to process and make sense of the event in the context of their history. 11

22 PERSON PRETRAUMA SEISMIC EVENT CHALLENGES MANAGEMENT OF EMOTIONAL DISTRESS FUNDAMENTAL SCHEMAS: BELIEFS AND GOALS LIFE NARRATIVE RUMINATION MOSTLY AUTOMATIC & INTRUSIVE SELF DISCLOSURE WRITING, TALKING, PRAYING REDUCTION OF EMOTIONAL DISTRESS MANAGEMENT OF AUTOMATIC RUMINATION DISENGAGEMENT FROM GOALS Sociocultural Influences RUMINATION (MORE DELIBERATE) SCHEMA CHANGE NARRATIVE DEVELOPMENT MODElS FOR SCHEMAS, COPING, POSTTRAUMATIC GROWTH ENDURING DISTRESS POSTTRAUMATIC GROWTH (5 DOMAINS) NARRATIVE AND WISDOM Figure 1. Tedeschi and Calhuon s Model of Posttraumatic Growth 12

23 These challenges lead to rumination about the event, in which the person is cognitively engaged in repetitive thoughts regarding the incident (Tedeschi & Calhoun, 2006). The authors note that the term rumination is often used in a negative manner, often denoting maladaptive thought patterns related to a specific event or situation. In contrast, Tedeschi and Calhoun use rumination in their model in a neutral way that is intended to describe the process of trying to make sense of the event. The rumination that occurs in the early stages of PTG involves mainly automatic and intrusive thoughts about the event that are consistent with the reexperiencing diagnostic criteria of both acute stress disorder and post traumatic stress disorder. This early phase of rumination is distinct from the later stage, which involves different processes. This early rumination phase is related to two parallel components of the PTG model, self- disclosure and a cluster that includes reduction of emotional distress, management of automatic rumination, and disengagement from goals (Tedeschi & Calhoun, 2006). The self-disclosure component relates to the amount and type of information that the person shares about the trauma event with others. It is posited that the development of PTG is facilitated, in part, by this sharing of the event through talking or writing because the attitudes and responses of the person s primary reference group are important in the development of their post-trauma perspective. The parallel cluster includes three parts, the first of which is reduction of emotional distress. The model posits that the early rumination leads to less emotional distress, as well as increased control over the automatic intrusiveness of the event. This increased management of automatic rumination, the second part of the cluster, allows for the person to process their thoughts about the trauma event in a self-controlled manner. The third part, 13

24 disengagement from goals, involves the attempt by the individual to reconcile their pretrauma life goals with their post-trauma experience. Some people find discord between these two aspects of their self-concept and may believe that they cannot achieve their pretrauma goals. This reflects damage to their worldview, including their self-efficacy. By disengaging from their pre-trauma goals the individual is able to incorporate the trauma into their life narrative and develop new goals. Sociocultural influences are a connected component of self-disclosure and the emotional distress/management of automatic rumination/disengagement from goals cluster (Tedeschi & Calhoun, 2006). The role of sociocultural factors includes both proximate and distal aspects. The proximate factors include the people with whom an individual interacts on a regular basis, which may include friends, co-workers, family members, and neighbors. In contrast, distal influences are broader and consist of the cultural themes that exist in one s larger society, such as countries or vast geographic zones. The influence of one s culture on their post-trauma experience can be positive, negative, or a combination of both. For example, the post-vietnam experience for many American soldiers was made more difficult by the cultural responses that they experienced, which in some cases included invalidation and even outright aggression. In contrast, the cultural responses to Iraq war soldiers seems to have been more supportive and positive, perhaps, in part, due to lessons learned from the Vietnam experience. These components in the model then lead to further rumination, but the process is now more deliberate and less automatic (Tedeschi & Calhoun, 2006). This stage of rumination includes changes to the person s schemas, their cognitive template of their beliefs and attitudes, and the development of a life narrative that incorporates the trauma 14

25 in a linear fashion (as opposed to the before and after style of early rumination). The authors posit that this more deliberate rumination phase leads to the development of PTG, which encompasses five domains, including, an increased appreciation of life, more meaningful interpersonal relationships, an increased sense of personal strength, change priorities, and a richer existential and spiritual life. An associated component of PTG in the model is enduring distress (Tedeschi & Calhoun, 2006). The authors conjecture that the development of PTG does not necessarily mean that the person does not experience distress related to their trauma experience. They argue that this is not a shortcoming of their conceptualization of PTG, rather, they view distress and PTG as separate dimensions that are not necessarily connected. That is, they believe that the two dimensions can coexist. What is more, the authors suggest that trauma survivors may require unpleasant cognitive and emotional reminders of the event in order for them to maintain their growth by remaining aware of both the losses and gains of their experiences. The final facet of the PTG model is narrative and wisdom (Tedeschi & Calhoun, 2006). The narrative portion refers to the achievement of the previously addressed process of developing a linear and trauma-inclusive life story. In particular, the person at this stage has constructed meaning through their trauma experience and has developed a narrative that includes personal, interpersonal, and social dimensions (Neimeyer, 2006). At the personal level, the individual incorporates stories from various episodes in their life in a manner that facilitates a linear sense of their self concept. At the interpersonal level, the trauma event is conveyed to others via verbal or written mediums. As noted earlier, PTG is more likely to occur when the other person provides empathy and support, 15

26 rather than invalidating the person s experience. Finally, at the social level, there are both individual and societal implications. The individual can benefit from feeling the support of their society. For example, the survivors of the September 11 th attacks were largely met with an outpouring of empathy and assistance. At the societal level, PTG in individuals can contribute to broader changes, in which the society is better able to deal with national crises. One example would be during World War II, when many people lost loved ones and there were countless sacrifices made at the individual and societal level in order for the nation to survive that trying period of history. In addition to the narrative, it is proposed that individuals who develop PTG also gain wisdom through their struggle with adversity. Though it has been defined in a myriad of ways, in this context wisdom is viewed as the ability to balance reflection and action, weigh the known and the unknowns of life, be better able to accept some of the paradoxes of life, and to more openly and satisfactorily address the fundamental questions of human existence (Tedeschi & Calhoun, 2004, p. 12). Posttraumatic Growth in Children Kilmer (2006) argues for a distinct PTG model for children. He notes that the developmental implications of children require a modified PTG approach in order to understand the phenomenon among younger people. In particular, the author posits that PTG in children is best informed by an ecological perspective that can consider the multilayered influences in a child s life. Though the Kilmer model deviates from the Tedeschi and Calhoun approach in important ways, it largely mirrors the main facets of the adult conceptualization of PTG. First, the child s pretrauma beliefs, characteristics, and functioning are considered. This takes into account a wide variety of factors, including 16

27 the child s temperament and their relationship with their parents and caregivers. Next, is the exposure to the trauma, which often includes shattered assumptions, loss, and grief. Among the potential mediators of trauma experiences are the severity, duration and type of trauma. Central to the child s post trauma experience is the caregiver s response to the event. This response is moderated by the parents or caregivers own mental health status, their pre-existing relationship with the child, their own stress reactions and coping resources. Sadly, many of the most trauma-vulnerable children in our society, those in the lower socioeconomic strata, are also more likely to have parents or caregivers whose ability to respond to the trauma event is compromised. The next phase of the model involves two parallel components, relationships/support and appraisals, rumination and cognitive reprocessing (Kilmer, 2006). In the relationships/support phase, the child s environment facilitates emotional expression and discussion of problems, provides validation, and assistance when necessary. This includes a range of environmental influences, including caregivers, parents, family members, and school and other community members. The parallel component of appraisals, rumination, and cognitive reprocessing involves the child experiencing recurrent trauma-related cognitions in an attempt to understand, resolve, and make sense of the experience. This process will vary depending on the child s developmental level and maturity. The appraisals, rumination, and cognitive reprocessing phase has a parallel component of cognitive resources: realistic control attributions (Kilmer, 2006). In the cognitive resources phase, the child attempts to reach an accurate perspective on what can and cannot be controlled in a person s world. These two components lead to self- 17

28 system functioning, in which the child achieves a sense of competency related to their ability to deal with problems. In addition, the child has the perception of increased selfefficacy and ability to handle social and interpersonal situations. Also, the child in this phase possesses hope and optimism about the future. Kilmer hypothesizes that these aforementioned components facilitate the attainment of the final stage in the model, posttraumatic growth. Assessment of Posttraumatic Growth Posttraumatic growth has been assessed in a variety of ways, utilizing both qualitative and quantitative methods (Park & Lechner, 2006). The qualitative methods generally consist of semi-structured questioning of the participant about growth-related issues. This approach has taken a variety of different forms, including written essays, lifestory narrative development, focus groups, and more commonly, individual interviews. Proponents of these qualitative methods to measure growth argue that quantitative methods do not capture the domains of PTG as well as qualitative methods. In contrast, those that favor quantitative methods argue that qualitative methods are of limited value because they do not possess adequate psychometric properties for comparing and contrasting findings in a consistent manner. Currently, there are three psychometrically validated quantitative measures that are used to measure PTG (Park & Lechner, 2006). These measures consist of the Posttraumatic Growth Inventory (PTGI), the Benefit Finding Scale (BFS), and the Stress- Related Growth Scale (SRGS). The most widely used and researched of these measures is the PTGI, which was developed by Tedeschi and Calhoun. The PTGI is a 21-item selfreport inventory that assesses the person s perception of positive changes that they have 18

29 experienced in the aftermath of a traumatic event. The PTGI uses a 6-point Likert scale ranging from 0 (I did not experience this change as a result of my crisis) to 5 (I experienced this change to a very great degree as a result of my crisis). The PTGI s five subscales include Relating to others, New Possibilities, Personal Strength, Spiritual Change, and Appreciation of Life. The range of possible scores is 0 to 105 and the total score is achieved by summing all the item responses. Higher scores on the PTGI are indicative of greater amounts of PTG. Tedeschi and Calhoun developed and normed the PTGI using a college student population. Research has shown that the full scale PTGI scale has acceptable psychometric properties (a =.90), while the five domain model has received less support from studies (Sheikh & Marotta, 2005). The PTGI has also been adapted for use with children by rewording the items to be appropriate for children as young as 8 years of age. A common criticism of the PTGI is that it only allows people to report positive growth experiences, while not assessing possible negative life changes related to trauma. The Benefit Finding Scale (BFS) was developed by Antoni et al (2001) for use with breast cancer survivors, though it has also been utilized with people with other types of cancer and HIV/AIDS. The BFS has 17 items and each one begins with the phrase Having cancer., which is then followed by a possible area of gain derived from the experience. The content of the scale items includes areas such as handling responsibilities and acceptance. The BFS utilizes a five-point Likert scale that ranges from a little to extremely. Though its use has been relatively limited to cancer and HIV/AIDS survivors, the BFS has been shown to have acceptable psychometric properties (a =.82). 19

30 The Stress-Related Growth Scale (SRGS) was developed by Park, Cohen, and Murch (1996) and was validated using multiple college student samples. The SRGS has 50 items and examines participants growth in personal resources, social relationships, life philosophy, and coping skills. The participants are given choices to respond from 0 (not at all) to 2 (a great deal). Research on the SRGS indicates that it measures a unitary construct and, thus, should be viewed as providing a single, global growth score. There is also a short form of the SRGS that was constructed using the 15 highest loaded items from the long form. In addition, Armeli, Gunthert, and Cohen (2001) have published a 43-item revised version (SRGS-R) of the measure that includes both negative and positive changes related to the trauma. The authors reported a seven factor structure with good psychometric properties for the SRGS-R that includes the following scales; affect regulation (a =.67), religiousness (a =.90), treatment of others (a =.75), selfunderstanding (a =.74), belongingness (a =.79), personal strength (a =.78), and optimism (a =.78). In developing the SRGS-R Armeli (2009) and his associates viewed growth scores as a continuous outcome. Growth scores on the SRGS-R were conceptualized either as decreases, no change, or increases. An important question in the study of PTG is, how much growth represents PTG? In other words, what levels of growth constitute a person being deemed as having achieved PTG? There are a number of issues, both theoretical and measurement-related, that need to be addressed in order to resolve this dilemma. Tedeshi and Calhoun (2006) have recognized this quandary and have taken the position that the answer does not lie in establishing cutoff scores. They argue that there is variability in the PTG scores across individuals and populations that contraindicate setting cutoff levels, since the variance 20

31 may be related to the highly personal and relativistic nature of growth. At the same time, some researchers argue that in order for PTG to be further developed as a theory, guidelines must be established so that comparisons and inferences can be drawn from the data. Previous Studies on Posttraumatic Growth The question of prevalence of the phenomenon of PTG in the population has also been raised. Tedeschi and Calhoun (2006) have cited research on PTG prevalence that ranges from 3% to 100% in various samples. However, they maintain that it is more common for rates of PTG to fall between 30% to 80% in published studies. Clearly, this is an area of PTG research that requires further exploration. In their meta-analysis of benefit finding and growth, Helgeson, Reynolds, and Tomich (2006) examined 77 articles. They found that growth was related to less depression and increased well-being. However, they also found that growth was associated with more intrusive and avoidant thoughts about the trauma event. Intrusive and avoidant thoughts are diagnostic symptoms of PTSD. The authors reported that time since the trauma event was a moderator, in that, people generally reported more growth the longer the span of time since the trauma. In addition, they found that women, minorities, and younger people reported the most growth. Importantly, in terms of the present study, the authors suggest that PTG may perhaps be best viewed as a coping strategy for more proximal events and growth for more distal events. Posttraumatic growth has been studied in a variety of populations (Park & Lechner, 2006). Cancer survivors are a commonly researched population in published PTG studies (Stanton, Bower, & Low, 2006). Stanton, Bower, and Low reviewed the 21

32 published PTG studies with cancer survivor populations and found there were 29 independent studies and seven sub-studies, in which the cancer survivors were not the exclusive population under examination. There were a variety of measures used in these studies, but the majority included either the PTGI or BFS. Only one of the studies (Cordova et al., 2001) reviewed used a control group and the results of that study indicated that women diagnosed with cancer reported significantly higher amounts of growth than those without cancer in the PTGI domains of relating to others, spirituality, and appreciation of life, but not in the areas of new possibilities or personal strength. Overall, the 29 studies reviewed found that participants reported small to moderate amounts of perceived growth that they related to their experience with cancer. The authors reported that their analysis indicated that, in general, breast cancer survivors of higher socioeconomic status (SES) who had completed treatment were more likely to report growth than those in lower socioeconomic strata. However, the opposite was true in cancer patients who were still engaged in treatment: in that, higher SES was actually related to decreased growth in that group, and the authors note that the PTG-SES relationship is still unclear. Of the 29 studies reviewed, 10 addressed the issue of PTG and ethnicity (Stanton, Bower, & Low, 2006). The authors found that in three of the studies ethnic minorities reported higher levels of PTG than white breast cancer patients. This finding held true even when controlling for SES. The other seven studies that addressed ethnicity reported nonsignificant findings in relation to PTG, but the reviewers noted that those studies had smaller samples and fewer minority participants, which may have impacted the findings. The authors suggest that PTG may be more common in minorities due to earlier age at 22

33 diagnosis and an increased impact due to higher rates of mastectomy and chemotherapy treatment in that population. PTG has also been reported in studies of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) patients (Milam, 2006). HIV and AIDS present complicated psychological issues, in part, due to the stigma that is attached to the disease and the corresponding psychosocial impacts. In his review of three studies in this population, Milam found that 59% to 83% of the participants reported PTG as a result of their experience with HIV/AIDS. Lev-Wiesel and Amir (2006) studied PTG among Jewish people (N = 97) who were children during the holocaust. The participants (48% male) were all children in Europe during World War II and were living in areas under Nazi command. At the time of the study their average age was (SD = 4.65). The findings indicated that the participants reported a small amount of growth and PTG was positively correlated with social support from friends and PTSD arousal symptoms. Interestingly, the authors noted that participants appeared to channel their increased arousal into adaptive behaviors. Grubaugh and Resick (2007) examined PTG among female assault victims who were seeking mental health treatment. The participants (N = 99) had experienced either a physical (36%) or sexual assault 64%) and their average age at the time of the study was (SD = 11.24). Almost all of the participants (90.9%) met DSM-IV diagnostic criteria for PTSD and 54.4% met criteria for both depression and PTSD. The authors reported the following PTG amounts in the sample: no growth (1%), very small (22%), small (32%), moderate (24%), great (11%), and very great (10%). There were no 23

34 statistically significant differences reported in the amount of PTG among the physical and sexual assault groups. In a study of survivors of Intimate Partner Violence (IPV), Cobb, Tedeschi, Calhoun, and Cann (2006) examined the dose-response theory of PTG. In the doseresponse theory it is posited that as the amount of trauma increases, including both duration and severity, there will be corresponding increases in the amount of PTG. The participants (N = 60) were all women who were living in domestic violence shelters. The average age of the women was 33 (SD = 10) and included white (48.3%), African- American (38.3%), and Hispanic (1.7%) participants, as well as some who did not report their ethnicity. The findings indicated that the participants reported a moderate amount of PTG and the authors noted that these levels were higher than those reported in many other populations studied, including breast cancer survivors. In relation to the doseresponse issue, the authors reported that of the six domains that were examined (relating to others, new possibilities, personal strength, spiritual change, appreciation of life, and total PTG) only appreciation of life had a significant correlation with severity of abuse, such that women who reported higher levels of abuse also reported more PTG. Milam, Ritt-Olson, and Unger (2004) examined PTG among adolescents at a Southern California high school. The participants (N = 435) had an average age of (SD = 1.52) and were balanced by gender (55 % female). The sample was made up ethnically of Hispanic (n= 373), multiethnic (n = 27), identified as other (n = 23), and white (n = 12). The participants primarily reported experiencing difficult life events in the following areas: death of close friend (34%), moved to a new home (16%), loss of a close friend (11%), major illness/injury to a close family member (10%), parents/guardians 24

35 divorced/separated (10%), held back a grade (6%), and major illness/injury (5%). The participants reported moderate amounts of growth in relation to the events. There were no differences found between males and females, or between Hispanics and non-hispanics. The highest average PTG score was associated with the death of a close family member and the lowest average score with a move to a new home. The study also addressed substance use and found it to be negatively correlated with PTG. Ickovics, et al. (2006) examined PTG over an 18-month period in urban adolescent teens. At the start of the study, the ages of the participants ranged from 14 to 19 (M = 17.24, SD = 1.49). The majority of the participants were ethnic minorities, including African American (43%), Hispanic (35%), white (10%), and other/mixed (2%). The researchers asked the teens to name the hardest thing that they ever had to face and 319 (97%) reported an event. The traumatic life events reported by the participants included pregnancy/motherhood (29.4%), death of a loved one (22.6%), relationship problems (17.1%), another person s problems (12.4%), health problems (9.6%), socioeconomic problems (5.6%), crime (1.7%), and sexual abuse/harassment (1.1%). The participants were studied at baseline and at an 18-month follow-up. The findings indicated small levels of PTG, with the appreciation of life domain having the highest levels. In addition, pregnancy and motherhood were associated with the most growth and interpersonal problems with the least. The authors reported that white participants had lower long-term distress and that short-term distress was significantly more severe than long-term distress. This finding provides support for the idea that distress generally subsides over time. 25

36 In contrast to other areas of psychological research, college student samples have not been used often in PTG research. This may be due to PTG researchers tendency to focus on specific populations of trauma survivors. However, Wild and Paivio (2003) conducted a study at a Canadian University that examined whether psychological adjustment, active coping, and emotion regulation predicted PTG. The participants (N = 193) were predominantly female (n = 170) and had an average age of (SD =.32). The ethnic makeup of the sample included white (76.2%), African-Canadian (8.3%), East Indian (4.1%), Latin-American (3.1%), Native-Canadian (0.5%), and those that described themselves as other (6.7%). The findings indicated that the participants reported an average amount of traumatic events (M = 2.62, SD = 1.68). The range of events reported ranged from 1 to 9, with 66 % of participants reporting multiple trauma events. The average amount of time since the trauma event was 1.30 years (SD =.13) and ranged from 0 to 5 years. The events reported included an other (44%) category (encompassing suicide/death of close friends or non-immediate family members, and accidents not involving a permanent disability), life-threatening illness of family member (32%), serious illness of a family member (31%), death of family member (28%), breakin (16%), rape (14%), family member s disability (14%), physical assault (12%), childhood emotional abuse (11%), natural disaster (10%), disability of self (10%), witness to a murder or life-threatening injury (8%), childhood physical abuse (6%), robbery involving force (4%), life-threatening illness of self (3%), divorce (3%), childhood sexual abuse (3%), and combat experience (1%). The results indicated that the participants, on average, reported moderate amounts of PTG. Also, higher levels of PTG were associated with higher amounts of trauma, more proximal traumas, and higher 26

37 levels of distress at the time of the event. The amount of PTG was associated with higher levels of active coping and greater subjective well-being. The authors note that social desirability was independent of PTG, which they argue supports the notion that PTG is not simply the result of the responder attempting to create a positive impression. Kleim and Ehlers (2009) addressed the relationship between PTG and psychological distress in a UK study of assault survivors. The authors investigated these issues in two different studies, one involving 180 people who had been treated for assault injuries at an inner-city hospital in the prior two weeks, and another that examined 70 assault survivors that had been treated in the same emergency room 3 to 15 months before data collection. The findings indicated a curvilinear relationship between PTG and depression in the first study, and a curvilinear relationship between PTG and PTSD symptoms in the second study. The authors reported that the assault survivors with low or high amounts of PTG endorsed lower distress levels than those reporting moderate amounts of PTG. It is posited that this is due to some people not viewing the event as traumatic and, therefore, not experiencing growth or distress in relation it. Conversely, people who do view the event as seismic in their life are more likely to experience growth and distress in relation to the event. The authors suggest that this high PTG/high distress group supports the hypothesis that PTG is adaptive for most people and that it ultimately leads to better adjustment. However, they also note that some assault survivors reported moderate levels of PTG that were related to distress at 6 months post-event. They suggest that this may be indicative of a possible positive illusion, in which PTG serves a palliative function and does not result in what Hobfoll (2007) termed action growth, meaning growth that has both cognitive and behavioral manifestations. 27

38 Shakespeare-Finch and Enders (2008) addressed the issue of improving the manner in which PTG is generally measured, including how to capture action growth. Specifically, they asked 61 Australian trauma survivors and a significant other to complete the Posttraumatic Growth Inventory (PTGI). The authors reported that the trauma survivors PTGI scores were corroborated by the significant other s report. They suggest that this provides support for the notion that PTG is not simply a cognitive illusion and is, in fact, manifested behaviorally. They do note, however, that there is a possibility that their findings alternatively reflect a cognitive illusion shared by the survivor and their significant other. Unresolved Issues in Posttraumatic Growth There are a number of unresolved issues regarding PTG (Park & Lechner, 2006). This may be due, in part, to its relative youth as a construct and focus of research. However, there are also divergent views within the field about both the theoretical and practical aspects of PTG. One of the issues in PTG that remains controversial relates to semantics. Some critics of PTG argue that it is not distinct from other salutogenic constructs, such as resilience. These critics charge that these constructs are mining the same ground, but simply using different terminology. Tedeschi and Kilmer (2005, p. 231) argue that resilience can best be defined as effective coping and adaptation in the face of major life stress, and that, in contrast, PTG goes beyond resilience and is related to people who have not only adjusted to the stressor, but have actually been transformed by their struggles with adversity. Furthermore, Lepore and Revenson (2006) note that some theorists believe that people who are resilient may actually be less likely to experience 28

39 PTG, since they are perhaps not as stressed by the event as others who are less resilient. While this issue will likely remain a point of contention in the field, PTG has established itself as a construct that has been widely researched and is currently the predominant theory addressing the positive impact of adversity. Another issue that remains unclear is whether PTG is an outcome or coping strategy (Zoellner & Maercker, 2006). Tedeschi and Calhoun (2006) maintain that PTG is an outcome of the individual s trauma experience. Essentially, the growth is an unintentional byproduct that is created through the coping processes of the person and is described in their model of PTG. In contrast, Davis, Nolen-Hoeksama, & Larson (1998) argue that PTG is an example of meaning making, in which the individual attempts to adapt to a trauma by attributing growth to the adversity. Some theorists question the adaptive utility of PTG in general. Hobfoll, et al. (2007) argue that PTG as Tedeschi and Calhoun conceptualize it is a positive illusion of sorts that seldom translates to adaptive action growth. The authors cite work conducted in New York after 9/11 and in Israel. In the 9/11 study (Bonanno, Rennicke, & Dekel, 2005) the results indicated that PTG was a cognitive coping strategy for survivors that did not lead to adaptive changes in functioning at 18-month follow-up. In their work in Israel (Hobfoll et al., 2006) during the Intifada they found that participants with higher levels of PTG also had higher amounts of functional impairment, PTSD symptoms, and greater outgroup bias. In a study they conducted in Gaza, PTG was indicative of positive adaptation only when it was associated with action and not simply cognitive coping mechanisms. 29

40 The Janus Face Model of Posttraumatic Growth Zoellner and Maercker (2006) proposed a two component model that was intended to provide a unified theory that takes into account the contradictory issues surrounding PTG. The Janus Face model, named after the Roman God Janus who was generally illustrated with two faces gazing in opposite directions, proposes that the contradictory findings in PTG research are due to the nature of the construct itself. Specifically, the Janus model suggests that PTG has both illusory and constructive components and that the length of time since the trauma event is a moderator in the trajectory of PTG. Also, Zoelner and Maercker posit that PTG can be both an outcome and a coping strategy. It is proposed that short-term, PTG is a coping strategy that serves a palliative function. During the proximal phase, it is expected that there will be more illusory aspects of PTG and fewer constructive aspects. See Figure 2 for an illustration of the proximal phase. Conversely, as the trauma becomes more distal, it is expected that there will be more constructive aspects and less of the illusory aspects. In addition, the Janus model predicts that distress will be greater in the proximal phase and reduced in the distal phase. See Figure 3 for an illustration of the distal phase. Only one study was found that attempted to test the Janus model. Zoellner, et al. (2008) conducted a study among motor vehicle accident survivors in Germany. They operationalized the illusory side of PTG as optimism and the constructive component as openness to experience and intense feelings. The study used the personality measures of the Life Orientation Test-Revised (LOT-R) and the NEO Personality Inventory-Revised (NEO-PI-R) to capture these constructs. The authors reported that there were no significant relationships between the optimism or the openness facets and PTG. 30

41 Proximal to Trauma Event Less Constructive Thinking More Illusory Thinking Higher PTG Levels Higher PTSD Symptoms Figure 2: Janus Model of Posttraumatic Growth: Proposed Trajectory of PTG: Proximal to Trauma (Zoellner & Maercker, 2006) Distal to Trauma Event More Constructive Thinking Less Illusory Thinking Higher PTG Levels Lower PTSD Symptoms Figure 3: Janus Model of Posttraumatic Growth: Proposed Trajectory of PTG: Distal to Trauma (Zoellner & Maercker, 2006) However, there was support for the Janus model in that optimism and openness played roles in the prediction of PTSD. In keeping with the model, participants with high levels of PTSD symptoms also had higher levels of optimism and higher levels of PTG. In contrast, those with lower PTSD symptoms also had higher levels of openness and PTG. The authors also reported a small dose-response effect, in which more severe trauma was 31

42 associated with higher levels of PTG. The authors noted that the PTG levels reported by the participants were generally very low and they suggested this may be due to cultural differences. They argue that in America there is a tyranny of positive thinking that may pull for higher scores in the United States. They contrast this with Germany, where people may be less likely to follow this cultural script. Statement of the Problem It should be clear by this point that there are many unresolved issues in PTG research. The present study was designed to address some of the central issues to contribute to a better understanding of PTG. In addition, the present study improved on some of the shortcomings of previous research. The present study built on the Zoellner, et al. (2008) study by testing the Janus Face model through examining facets representing the illusory and constructive components of PTG. The illusory component was measured by the constructs of optimism, self-deception, and locus of control. The constructive components were addressed by measuring capacity to love, resourcefulness, and wisdom. These six constructs were chosen in order to capture the illusory and constructive facets under study, and because they are well-researched personality domains. This represents a revision and expansion of the constructs used in the only previously published study identified in which the Janus model was investigated. The following hypotheses are proposed: 1) Level of event-related psychological distress, conceptualized as PTSD symptoms (as measured by the Purdue Posttraumatic Stress Disorder Scale-Revised) will contribute to 32

43 the prediction of scores on the illusory and constructive scales (using six scales drawn from the International Personality Item Pool). 1a: Specifically, the illusory (optimism, locus of control, and self deception) scales will be positively related to higher levels of PTSD-related distress. 1b: The constructive scales (capacity for love, resourcefulness, and wisdom) will be negatively related to lower levels of distress. 2) There will be a positive relationship between PTG, as measured by the Stress-Related Growth Scale-Revised, and trauma severity. Trauma severity is conceptualized here as being related to two constructs. First, whether the person reported having perceived a threat to their physical safety at the time of the event. Second, the number of potentially traumatic events that the individual reported having experienced. 3) PTG levels will be positively correlated with both the illusory and constructive scale scores. Exploratory Research Questions 1) The relationship between reported event- related distress (as measured by the Purdue Posttraumatic Stress Scale- Revised), trauma severity (as measured by the number of reported potential traumatic events and the reported number of times that the participant was in physical danger during such an event), and the reported time that has elapsed since the focal trauma event will be explored. 2) The relationship between posttraumatic growth (as measured by full scale scores on the Stress-Related Growth Scale-Revised), trauma severity (as measured by the number of reported potential traumatic events and the reported number of times that the participant was in physical danger during such an event), and the constructive constructs 33

44 (as measured by the Capacity For Love, Resourcefulness, and Wisdom scales) will also examined. 3) Finally, the relationship between the Posttraumatic Growth subscales (as measured by the Changes To Self, Changes To Relationships With Others, Changes To Perspective On Life, and Changes in Religiosity subscales of the Stress-Related Growth Scale- Revised), and the constructive constructs (as measured by the Capacity For Love, Resourcefulness, and Wisdom scales) will be investigated. 34

45 Chapter 3 Method Participants One hundred twenty six undergraduate students (55% women and 45% men, mean age 19.7 years) volunteered to participate in the study. Participants were recruited through the University of Toledo psychology participant pool system. The system is webbased and students are able to review the various research opportunities available and sign up for studies of their choice. Approval was obtained from the Institutional Review Board (IRB) at the University of Toledo prior to posting the study for students to sign up The participants were undergraduate students who received course credit for their participation in the study. The students are given the option of earning the credit in an alternate manner if they choose to not participate in a study. Of the 127 participants that signed up for the study only one did not participate. All the data was collected in the University of Toledo psychology department during the month of April See Appendix A for the consent form. Researcher The researcher was a 41-year-old male, fourth-year graduate student in a clinical psychology doctoral program. All research sessions were run by the researcher and all data was secured by him exclusively. The researcher had training and experience in research methods and clinical issues. 35

46 Procedure The research sessions were posted on the subject pool website and interested participants signed up for a time slot of their choosing. The description of the study indicated that it included questions about traumatic events and/or life struggles they may have endured and how it impacted them. It was anticipated that participants would be able to finish the study in an hour or less. Five participants were scheduled for each session at half hour increments. Since participants sometimes took longer than thirty minutes to complete the study, there was some overlap between sessions. However, this did not lead to any difficulties with the procedures or data collection. Once a participant arrived they were given a consent form. The researcher gave them a brief description of the form and asked if they had any questions or concerns. Once the participant signed the form (no participants declined to sign) they were given the first section of the study, which included a brief demographic section (consisting of age, gender, ethnicity, and marital status) and a modified version of the Trauma Events Interview (TEI), a trauma screener that was designed to determine if they reported having experienced any potentially traumatic events. See Appendix G for the complete protocol. These events were considered to be possible common sources of traumatic responses, but certainly not in all people. After completing the second section of the protocol they turned it into the researcher, who reviewed it. Based on past research, it was expected that the majority of participants would report some type of potentially traumatic event. However, if they did not report any such events, they were given a debriefing form and told that their participation in the study was complete. The reasoning for this procedure was that if no potentially traumatic events were reported, including the item that allows 36

47 the respondent to list an event that was not present on the list, then proceeding further with the growth items was deemed unnecessary. In the present study, 85% of the participants endorsed at least one potentially traumatic event. A total of 18 participants (15%) were excluded after the second part of the study. If the participant did endorse a potentially traumatic event they were given the second section that contained the other measures in the protocol. These consisted of a trauma symptom measure (PPTS-R) intended to capture distress related to the reported event, the 43-item Stress-Related Growth Scale-Revised (SRGS-R) and a 68-item measure culled from the International Personality Item Pool (IPIP) that examines the six constructs of optimism, locus of control, self-deception, resourcefulness, wisdom, and capacity to love. After turning the measures into the researcher, the participants were asked if they had any questions and were given a debriefing information sheet. See Appendix B for the debriefing sheet. The information sheet provided information about common questions about and reactions to traumatic events. The researcher stressed to each participant to contact him via provided contact information if they had any questions or concerns after leaving the study. No participants contacted the researcher. It was not anticipated that any participant would have a severe adverse reaction to taking part in the study, but these precautions were put in placed to provide reasonable assistance if such a situation arose. The confidentiality of the participant and their data was of the utmost concern. In order to maintain confidentiality, all data was collected and analyzed using a number code assigned by the researcher. The number code was not associated with the participant s name and the consent forms were filed separately from any data. The paper 37

48 data was secured by the researcher in a University psychology department office. The analysis of the data took place on a secure computer and the researcher was the only person with access to that data. Measures Demographic questions were included in the first section. All measures were administered in paper and pencil form. The demographic section requested the participant s age, gender, ethnic affiliation, and marital status. Traumatic Events Interview (TEI). The Trauma Screener used the first 13 items of the Traumatic Events Interview (TEI) (Sprang, 1997). These items are part of an interviewbased measure that has been adapted to written form for the purpose of this study. See Appendix C for the original scale and Appendix G for the revised version included in the complete protocol. Participants are asked if they have experienced various potentially traumatic events, such as a natural disaster or a life-threatening illness. The participant responds using a scale from 0 = no, 1 = witnessed, 2 = experienced, 3 = confronted with, 4 = some combination of 1, 2, and / or 3. Then, the participant is asked to list how many times the event happened. Next, they are asked, how old were you at the time of the worst incident? The structure of the TEI was slightly modified by the researcher in order to increase face validity with the population under study. It was projected that these changes would not negatively impact the construct validity of the measure. Specifically, the TEI previously contained an item asking if the respondent experienced fear, horror, or helplessness during the event. This item is based on DSM-IV diagnostic criteria and is addressed in this study by the PPTS-R measure. For the present study the item was deemed redundant and removed. 38

49 In order to measure trauma severity, an item was added that asked the respondent, During the worst incident, were you in physical danger of injury or death? The respondents are asked to respond yes or no. A response of yes contributed to a positive score on the item. The participant s scores on the item were summed with the number of potentially traumatic events that the participant reported to arrive at a trauma severity scale score. Higher scores are indicative of greater trauma severity. Purdue PTSD Scale-Revised (PPTS-R). The Purdue PTSD Scale-Revised (PPTS-R) was used to measure the participants PTSD symptoms. See Appendix D for the complete measure. The PPTS-R (Lauterbach & Vrana, 1996) is a17 item self-report measure that reflect the symptoms within the DSM-IV PTSD criteria B, C, and D. Most participants were able to complete the measure in 10 minutes or less. At the beginning of the measure the participant is asked to identify the most traumatic and/or stressful event they have ever experienced and to complete the PPTS-R in relation to that identified event. Participants were also instructed to rate the frequency of symptoms within the previous month for each item. The response format is a Likert scale that ranges from 1 (not at all) to 5 (often). The PPTS-R has been shown to have good psychometric properties; total (a =.91), reexperiencing (a =.84), avoidance (a =.79), and hyperarousal (a =.81). Stress-Related Growth Scale-Revised (SRGS-R). The Stress-Related Growth Scale- Revised (SRGS-R) was administered to measure posttraumatic growth. See Appendix E for the complete scale. In its original form all the items were positively worded. The measure was revised by Armeli, Gunthert, and Cohen (2001) in order for participants to be able to report both negative and positive change related to trauma events. By using this measure it was possible to obtain less restricted and more nuanced data from the sample. 39

50 The revised version contains 43 items that the participant is instructed to answer in relation to a trauma event, such as My belief in how strong I am. The response format is a Likert scale that ranges from 1 = greatly decreased to 7 = greatly increased. In comparison to the PTGI, which has tended to yield a one-dimensional growth score in factor analyses, the authors reported that the SRGS-R resulted in seven distinct domains. These domains consist of treatment of others, religiousness, personal strength, belongingness, affect-regulation, self-understanding, and optimism. The authors reported that the revised scale had acceptable psychometric properties, with internal consistency scores ranging from.67 to.90. Illusory and Constructive dimensions. The constructs representing the illusory (selfdeception, optimism, and locus of control) and constructive (capacity to love, resourcefulness, and wisdom) dimensions were measured using individual scales from the International Personality Item Pool (Goldberg, 1999). The International Personality Item Pool (IPIP) is a freely available web-based test bank that was developed to provide no-cost personality measures for researchers. The impetus for the IPIP was the proliferation of proprietary research measures, such as the NEO-PI-R, that charge fees and are generally restrictive in their research use even when one purchases access to the measures. Researchers involved in the IPIP project have developed comparable versions of proprietary measures that have good psychometric properties with the following internal consistency scores; self-deception (a =.80), optimism (a =.86), locus of control (a = 86), capacity to love (a =.70), resourcefulness (a =.83), and wisdom (a =.75). See Appendix I for the IPIP complete items that were used. The self-deception scale consists of 10 items (five positively worded and five negatively worded), the optimism scale 40

51 consists of 10 items (four positively worded and six negatively worded), the locus of control scale consists of 20 items (ten positively worded and ten negatively worded), the capacity to love consists of 9 items (six positively worded and three negatively worded), the resourcefulness scale consists of 10 items (five positively worded and five negatively worded), and the wisdom scale consists of 9 items (six positively worded and three negatively worded). A PsycINFO search in September of 2008 showed that the IPIP had been used as a measure in a total of 138 published studies since This included 132 peer-reviewed articles, five dissertations, and one book chapter. 41

52 Chapter Four Results Participants The participants (N = 126) represented a largely homogeneous sample, with limited diversity in age, race, and marital status. Age ranged from 18 to 42 years. Gender favored females slightly (70 females and 56 males, mean age = 19.7), and the sample was overwhelmingly European American(85.7%), though other groups were represented to some degree (African-American = 5.6%, Asian = 4.8%, Biracial = 1.6%, Other = 1.6, and Hispanic =.8%). The sample was also almost entirely single and never married (96.8%). The sample that endorsed at least one potentially trauma event represented 85% (n= 108) of the population and was, not surprisingly, very similar in makeup. The trauma sample was slightly more even in gender (57 female and 51 male) and the ages ranged from 18 to 42 (mean age = 19.65). The trauma sample was again overwhelmingly EA (86.1%), with other groups represented to some degree (African-American = 6.5%, Asian = 3.7%, Biracial = 1.9%, Other =.9, and Hispanic =.9%). The trauma sample was again also almost entirely single and never married (97.2%). Preliminary Analyses SPSS version 17 was used in the analysis. Once entered into a data base, measures of central tendency were calculated for the variables. Bivariate correlations and a series of regression analyses were then completed. 42

53 Total Scores Stress-Related Growth Scale-Revised. Posttraumatic growth was measured using the Stress Related Growth Scale- Revised (SSRGS-R). Total scale scores were computed by summing all 43 items together. See Table 2 for the item means and standard deviations. In their revision of the original SSRGS Armeli et al (2001) reported that a seven factor solution was preferable to viewing the measure as a unitary construct. These seven domains consisted of treatment of others, religiousness, personal strength, belongingness, affect-regulation, self-understanding, and optimism. Theirs is the only published study addressing the psychometric properties of the revised version. However, in the present study, some of these domains did not show acceptable internal consistency. In particular, the Treatment of Others scale was particularly weak (a =.411). The other scales ranged from moderate to high internal consistency; religiousness (a =.89), personal strength (a =.69), belongingness (a =.60), affect-regulation (a =.69), selfunderstanding (a =.68), and optimism (a =.82). The full 43-item scale showed high internal consistency (a =.92). Next, scales were developed to mirror the primary theorized posttraumatic growth subcategories of changed sense of relationship with others, changed sense of self (feeling more vulnerable, yet stronger), and changes in life philosophy. These scales were analyzed and found to have high internal consistency (relationship with others (11 items, a =.86), sense of self (14 items, a =.84) and life philosophy (12 items, a =.81). The life philosophy scale had one problematic item ( Not taking things for granted ) and by deleting the item the consistency of the scale went from.68 to.81. No other items were deleted. 43

54 However, a fourth scale with four items reflecting religious content was also developed and showed the highest internal consistency (a =.91). The inter-item correlations for the scales were as follows; relationship with others (.11 to.64), sense of self (-.01 to.54), life philosophy (-.04 to.70), and religiosity (.63 to.90). Based on the acceptable psychometric properties of these newly developed scales they were used, along with the total score, as the measures of growth. See Table 2 for the newly developed subscales, which are noted in superscript. See Table 3 for the subscale means and standard deviations. Table 2 Item Means for SRGS-R: Full Scale Item M SD 1. My belief in how strong I am. a Acceptance of others. b Respect for others feelings and beliefs. b Treating others nicely. b My satisfaction with life. c Looking at things in a positive way. c Faith in God. d Taking responsibility for what I do. a Not taking things for granted. e Trust in God. d Ability to make my own decisions. a Feeling that I have something of value to teach others about life. a 13. Understanding of how God allows things to happen. d

55 14. Appreciation of the strength of others who have had a difficult life. c 15. Not freaking out when a bad thing happens. a Thinking about the consequences of my actions. a Not getting angry about things. c Being optimistic. c Approaching life calmly. c Being myself and not what others want me to be. a Accepting myself as less than perfect. a Taking life seriously. c Working through problems and not just giving up. a Confidence in myself. a Not taking my physical health for granted. c Listening more carefully when others talk to me. b Reaching out to help others. b Openness to new information and ideas. c Communicating more honestly with others. b Ability to deal with uncertainty. a Feeling that it s okay to ask others for help. b Not letting little things upset me. c Standing up for my personal rights. a My understanding that there are many people who care about me. b 35. My understanding that there is a reason for everything. c My sense of belonging. b Feeling as if I am part of a community. b My belief in a supreme being. d Ability to deal with hassles. a The meaning in my life. c

56 41. The meaningfulness of a prior relationship with another person. b 42. Ability to express my feelings. a Feeling as if I have a lot to offer other people. b Note. a = Changes in Sense of Self, b = Relationships with Others, c = Changes in Life Philosophy, d = Changes in Religiosity, e = Item Deleted From Life Scale Table 3 Stress-Related Growth Scale-Revised: Scale Scores for Overall Sample Subscale M SD Changes in Sense of Self Changes in Relationships with Others Changes in Life Philosophy Changes in Religiosity Total Scale As stated earlier, Armeli (2009) views the SSRGS-R as a continuous measure and there are no established cutoffs for growth. This is consistent with other PTG-related measures. For the purposes of analysis, item responses were recoded to reflect either decreases, no change, or increases in growth areas. The recoded responses ranged from -3 to +3, with higher scores indicating positive growth. A score of zero reflected neither an increase or decrease in growth. The highest score possible on the SRGRS-R is +/ See Table 2 for overall means and standard deviations of the scales. 46

57 Overall, participants reported small to large amounts of growth on the individual items, ranging from a low of.21 ( Not getting angry about things ) to a high of 2.19 ( Not taking things for granted ). The scores indicated a wide variation in the reported growth. The scales also reflect small to large amounts of reported growth with large standard deviations, suggesting that there was considerable variability in how participants responded to items. See Appendix H for Stress-Related Growth Scale-Revised Scale Scores by Trauma Event. International Personality Item Pool The illusory and constructive constructs were measured by three scales each. The illusory scales consisted of optimism (10 items), self deception (10 items), and locus of control (20 items). The constructive scales were resourcefulness (10 items), capacity for love (9 items), and wisdom (9 items). Reliability analysis for the present study indicated generally good internal consistency; optimism (a =.86), self deception (a =.78), and locus of control (.83), resourcefulness (a =.87), capacity for love (a =.71), and wisdom (a =.60). All six scale items were randomly placed in one full measure. A total of 28 items were reverse scored. There were six items that loaded on more than one scale. The scale was designed to include 59 items, however, item 26 ( I see difficulties everywhere ) was repeated as number 43 in error. This unintentional validity measure indicated close agreement on the two measures (item 26 mean = 3.00 item 43 mean 2.88). A score of 3 indicated that the item was neither accurate or inaccurate and any score over 3 reflected a positive contribution to the scale total. As previously noted, these scales were developed and made freely available online as part of the International Personality Item Pool. See Table 4 for item content, means and standard deviations. 47

58 Table 4 International Personality Item Pool Item Scores Item M SD 1) I feel comfortable with myself. a,b,c ) I know that my decisions are correct. b ) I panic easily (R). d ) I make a decision and move on. c ) I am less capable than most people (R). c ) I am not always honest with myself (R). b ) I am good at many things. d ) I believe that my success depends on ability rather than luck. c 9) I complete tasks successfully. d ) I worry about what people think of me (R). b ) I always know why I do things. b ) I can express love to someone else. e ) I feel that my life lacks direction (R). a,c ) I act comfortably with others. c ) I am rarely consulted for advice by others (R). f ) I am willing to take risks to establish a relationship. e ) I formulate ideas clearly. d ) I like to take responsibility for making decisions. b,c

59 Table 4 (continued) International Personality Item Pool Item Scores Item M SD 19) I know that I will be a success. a.b,c ) I am easily discouraged (R). d ) I am not good at figuring out what really matters (R). f 22) I believe some people are born lucky (R). c ) I often feel depressed (R). a ) I have difficulty accepting love from anyone (R). e ) I have an excellent view of the world. f ) I see difficulties everywhere (R). a,c ) I face problems directly. d ) I know that some others accept my shortcomings ) I love life. c ) I consider myself to be a wise person. f ) I come up with good solutions. c ) I am the most important person in someone else s life. e 33) I have a low opinion of myself (R). b ) I sometimes have trouble making up my mind (R). b ) I take the initiative. c ) I feel up to any task. c ) I feel isolated from other people (R). e ) I feel that I am unable to handle things (R). c ) I believe that unfortunate events occur due to bad luck (R). c 49

60 Table 4 (Continued) International Personality Item Pool Item Scores Item M SD 40) I know that there are people in my life who care as much for me as for themselves. e 41) I can t make up my mind(r). d ) I have a broad outlook on what is going on. f ) I see difficulties everywhere (R). a,c ) I am easily intimidated (R). d ) I lose sight of what is important in life (R). f ) I believe that the world is controlled by a few powerful people (R). c 47) I know someone who I really care about as a person. e 48) I am considered to be a wise person. f ) I constantly blow my chances (R). c ) I do not easily share my feelings with others (R). e 51) I dislike myself (R). a,b,c ) I have a dark outlook on the future (R). a ) I have been described as wise beyond my years. f 54) I can handle complex problems. d ) I seldom feel depressed. a ) I dislike taking responsibility for making decisions (R). c 57) I have a mature view on life. f ) I look at the bright side of life. a ) I wait for others to lead the way (R). d ) I am often in a bad mood (R). a Note. a = optimism, b = self deception, c = total locus of control, d = resourcefulness, e = capacity for love, f = wisdom, R = Reverse Coded. 50

61 In general, participants responded in a positive manner to the items, in the sense that most of the mean responses asserted a positive view of themselves. This response style suggests an overall positive skew in the sample toward the items. The item means ranged from 2.22 ( I sometimes have trouble making up my mind ) to 4.63 ( I know someone who I really care about as a person ). See Table 5 for the scale means and standard deviations. Table 5 The International Personality item Pool Scale Scores Scale M SD Illusory Scales: Optimism Total Locus of Control Self Deception Constructive Scales: Resourcefulness Capacity for Love Wisdom The scale scores also illustrate the positive skew of the responses. It is notable that the standard deviations for the IPIP scales are far below those of the SSRGS-R scale. See appendix I for International Personality Item Pool Scale Scores by Focal Event Type, which is the main trauma event reported by the participant. 51

62 Bivariate Correlations Pearson s correlations were calculated for all the scales and demographic variables in the data set. See Table 6 for bivariate correlations of major study variables. There was a significant positive correlation between age and trauma severity (.23, p <.05.), suggesting that the older a participant was, the more likely they were to have experienced an event in which they were in physical danger. Table 6 Bivariate Correlations Between Major Study Variables Measure PPTS-R ** -.24** -.22* -.24* ** 2. PTG *.16.26**.45**.02.30** Opt **.79**.48**.50**.57** Self **.29**.69**.61** TLC **.71**.65** Cap ** Res ** Wis Sev Time --- Note. PPTS-R = Purdue Posttraumatic Stress Scale-Revised total score, PTG = Stress- Related Growth Scale-Revised total score, Opt. = Optimism scale score, Self = Self Deception scale score, TLC = Total Locus of Control scale score, Cap. = Capacity for Love scale score, Res. = Resourcefulness scale score, Wis. = Wisdom scale score, Sev. = Trauma Severity scale score, Time = Time elapsed since trauma event * p <.05. ** p <

63 In terms of gender, males reported a significantly (z = -24, p <.05.) longer period of elapsed time since their trauma event than females (the mean for males was 6.06 years (SD = 6.02) and the mean for females was 3.54 (SD = 3.73). Males also scored higher (.26, p <.05.) on the IPIP resourcefulness scale (the mean for males was (SD = 6.11) and the mean for females was (SD = 6.40). Correlations suggest that distress was not related to PTG scores but was positively correlated (.23, p <.05.) with time elapsed since trauma. This suggests that the younger a person was when they experienced their trauma event, the more they are currently distressed by it. In relation to this finding, distress was also highly positively correlated (.64, p <.01.) with trauma severity, indicating that the younger a person was when their event occurred the more likely they were to be in physical danger. The posttraumatic growth scales were not significantly related to distress but were significantly positively correlated with the IPIP scales of optimism, total locus of control, capacity for love, and wisdom. Interestingly, PTG was not significantly correlated with resourcefulness, suggesting that the resourcefulness scale is measuring something less related to PTG than the other IPIP scales. The International Personality Item Pool scales of optimism (-.33, p <.01.), total locus of control (-.21, p <.05.), self deception (-.22, p <.05.), and capacity for love (-.23, p <.05.) were significantly negatively correlated with distress. This suggests that as participant s reported more distress, they were less likely to endorse feeling positive about the future and their ability to control the outcomes of events in their life. However, in the case of the capacity for love scale, they were also less likely to report feeling a capacity for developing, maintaining, and enjoying loving relationships. 53

64 Rates By Reported Trauma Trauma Events Inventory. On the TEI, participants reported experiencing a wide range of potentially traumatic events. Participants generally reported experiencing more than one potentially traumatic event (M = 2.26, SD = 1.43) with a range of 1 to7 endorsed. See Table 7 for the TEI items and response rates. When asked whether they have experienced any other traumatic event that was not listed, 16% replied that they had. Of those that endorsed the item, 20% reported that they were in danger during the event. When asked how many times they experienced an event of this type, the responses ranged from 1 to 3, with 73.7% reporting one such incident (mean age at time of incident = 13.56) The events listed consisted of (in participants own words) death of four family members in one year, parent s divorce, house fire, best friend s abortion, house hit by lightning, boyfriend s suicide attempt, family member s cancer, having to physically stop a suicide, witnessing a serious car accident, mother s death from cancer, brother s open heart surgery, witnessing friend being hit by car, family car catching fire (no one inside), mother s death, machine falling on father, brother fell down steps, and grandfather died in front of participant. 54

65 Table 7 Response Rates for Potentially Trauma Events on the Traumatic Events Inventory (TEI) Type of Potential Trauma Event Percentage of Endorsement Mean Age Natural Disaster 41% Serious Accident/Injury 32% Sudden Life Threatening Illness 10% Combat Exposure/War Zone.8% Accidental Death/Murder of other 22% Suicide of other 27% Attacked/Witnessed Attack (no weapon) 10% Attacked/Witnessed Attack (with weapon) 10% As Child Beaten/Witnessed Family Violence 17% Before Age 13, coerced sexual activity 7% Unwanted Sexual Contact (no force) 11% Unwanted Sexual Contact (with force) 6% Other Trauma Event 16% The participants who endorsed at least one trauma were asked to report the most traumatic and/or stressful life event they have ever experienced. They were instructed to complete the PPTS-R and the SRGS-R items in relation to the focal event they specified. Participants reported a wide range of events, encompassing 30 different categories. See 55

66 Table 8 for a complete listing in ascending order of response (Note: When more than one event has the same number of responses, they are in alphabetical order). In general, the death of someone close to them emerged as the most common event listed. However, there were 12 traumatic events that only one person reported. There was also a wide variation in the reported amount of time (M = 4.71 years, SD = 5.07 years) since the focal event occurred, with responses ranging from 0 years (indicating that the event occurred in the past 12 months) to 35 years. Table 8 Reported Focal Trauma Events Event Type Number of Participants Reporting Death of Grandparent 16 Death of Friend 15 Car Accident 11 Sexual Assault/Molestation 7 Death of Other Family Member 5 Parent s Divorce 5 Serious Illness of Loved One 5 Other Serious Accident 4 Physical Abuse 4 Serious Illness of Self 4 Incarceration of Parent 3 56

67 Table 8 (continued) Reported Focal Trauma Events Event Type Number of Participants Reporting Assault 2 Flood 2 Suicide Attempt of Loved One 2 Witnessed Domestic Violence 2 Witnessed Serious Accident (non-relation) 2 Witnessed Violence 2 Best Friend s Abortion 1 Combat Death of Sibling Eating Disorder Hospitalization for Depression House Fire Lengthy Separation from Family Period of Loneliness and Fear Pet Died Robbery Witnessed Serious Accident (relation) Note. n = 108. Trauma severity was measured by summing the number of events on the TEI that the participant reported as being a threat to their physical safety (involving possible injury or death) and the number of potentially traumatic events the participant endorsed. Results indicated that on average participants reported slightly less than one (M =.71, SD = 1.09) event in which they were in physical harm or received an injury. The responses ranged 57

68 from 0 to 7. Participants endorsed experiencing slightly more than two potentially traumatic events (M = 2.26, SD = 1.43) Purdue Posttraumatic Stress Disorder Scale-Revised. The Purdue PTSD Scale (PPTS-R) was used to measure distress related to the focal trauma event. Analysis indicated that the internal reliability of the measure was good (a =.88). In general, distress scores across the sample were low to moderate. See Table 9 for item means and standard deviations. The original scale was recoded for analysis so that a score of zero on an item meant no distress at all. Consequently, the recoded scale is as follows; 0 = Not at all, 1 = Rarely, 2 = Sometimes, 3 = Regularly, and 4 = Often. Higher scores indicate more distress. The item means ranged from.31 ( Have you lost interest in or more of your usual activities since the event?) to 1.45 ( Did you feel very upset when something happened to remind you of the event? ). Total scores for each participant were obtained by summing each score together. Table 9 Item Means on the Purdue Posttraumatic Stress Scale--Revised Item M SD 1) Were you been bothered by memories or thoughts of the even when you didn t want to think about it? 2) Have you dreamed about the event? ) Have you suddenly felt as if you were experiencing the event again? 4) Did you feel very upset when something happened to remind you of the event? 5) Did you avoid activities or situations that might remind you of the event? 58

69 Table 9 (cont.) Item Means on the Purdue Posttraumatic Stress Scale--Revised Item M SD 6) Did you avoid thoughts or feelings about the event? ) Did you have difficulty remembering important aspects of the event? 8) Did you react physically (heart racing, breaking out in a sweat) to things that reminded you of the event? Since the event. 9) Have you lost interest in one or more of your usual activities (examples: work, hobbies, entertainment)? ) Have you felt unusually distant or cut off from people? ) Have you felt emotionally numb or unable to respond to things emotionally the way you used to? ) Have you been less optimistic about the future? ) Have you had more trouble sleeping? 14) Have you been more irritable or angry? ) Have you had more trouble concentrating? ) Have you found yourself watchful or on guard, even when there was no reason to be? ) Are you jumpy or easily startled by noises? Note. n =

70 With some trauma groups encompassing only one participant, it is difficult to make comparisons between them. However, it is worth noting that those reporting a flood as their focal event (n = 2) reported the lowest amount of distress (M =.51), while the participants that listed suicide attempt of a loved one (n = 2) reported the highest distress (M = 37.50). Across the sample, the mean was and the standard deviation was The maximum score on the PPTS-R is 68. The range of distress scores was 55 with a low of 0 and a high of 55. Given the large standard deviations of PPTS-R scores, median scores were reported, as the median full scale score was 9.00 and the item scores indicated that the median for 13 of the 17 items was zero. This indicates that a subset of higher scores on the PPTS-R was significantly raising the mean scores. See Appendix J for PPTS-R Scores by focal trauma events. Primary Analysis A regression analysis was planned to investigate whether distress scores on the PPTS-R would contribute to the prediction of scores on the illusory and constructive IPIP scales. Specifically, a linear relationship was predicted. It was projected that distress scores would increase as the illusory scale scores increased. It was also predicted that as distress scores increased the constructive scores would decrease. Correlational analysis indicated that this relationship as predicted did not exist in this sample. Consequently, the planned regression analysis was not completed. A series of regression analyses was carried out to examine various other predictor models. All regressions were linear analyses and a level of.05 was used for entry and.10 was put in place for removal from the model. 60

71 Table 10 shows the results of a regression examining PPTS-R distress scores and trauma severity as predictors of time elapsed since trauma event. Analysis indicated that the model had small predictive properties, accounting for 17% of the variance in the time elapsed since the trauma event (F = 10.84, p <.01). Table 10 Predictors of Time Elapsed Since Trauma Event Time Elapsed Since Trauma Event Predictor Δ R 2 β Step 1.05* PPTS-R Distress Score -.23* Step 2.12** PPTS-R Distress Score -.31** Trauma Severity.35** Total R 2.17** n 106 Note. * p <.05. ** p <.01. A second regression analysis was conducted investigating age at the time of the trauma event and trauma severity as predictors of distress scores on the PPTS-R. See Table 11 for the results. The results indicated that the model had small predictive qualities, accounting for 17% of the variance in the time elapsed since the trauma event (F = 11.08, p <.01). A third regression analysis was conducted examining the three IPIP constructive scales (capacity for love, resourcefulness, and wisdom) and trauma severity as predictors 61

72 of full scale PTG scores on the SSRGS-R. See Table 12 for the results. The analysis indicated that the model had moderate predictive qualities, accounting for 26% of the variance in the PTG scores (F = 9.07, p <.01). Table 11 Predictors of Purdue Posttraumatic Stress Disorder Scale-Revised Distress Scores Purdue Posttraumatic Stress Disorder Scale-Revised Distress Scores Predictor Δ R 2 β Step 1.06* Trauma Severity.24* Step 2.12** Trauma Severity.27** Age At Time of Event.34** Total R 2.18** n 106 Note. * p <.05. ** p <

73 Table 12 Predictors of Full Scale Stress-Related Growth Scale-Revised Scores Full Scale Stress-Related Growth Scale-Revised Scores Predictor Δ R 2 β Step 1.01 Trauma Severity.08 Step 2.22** Trauma Severity.06** Capacity For Love.46** Step 3.00 Trauma Severity.06 Capacity For Love.47 Resourcefulness -.04 Step 4.04* Trauma Severity.06* Capacity For Love.40* Resourcefulness -.18* Wisdom.24* Total R 2.18** n 107 Note. * p <.05. ** p <.01. Three separate regression analyses were conducted investigating the four SSRGS- R subscales (changes to self, changes in relationships with others, changes in philosophy of life, and changes in religiosity) as predictors of scores on the IPIP constructive scales (capacity for love, resourcefulness, and wisdom). See Tables 13, 14 and 15 for the results. The analysis indicated that the models had small to moderate predictive qualities, accounting for 31% of the variance in the capacity for love scores (F = 11.43, p <.01), 63

74 12% of the variance in the resourcefulness scores (F = 3.80, p <.01), and 16% of the variance in the wisdom scores (F = 5.00, p <.01). Table 13 Predictors of Capacity For Love Scale Scores Capacity For Love Scale Scores Predictor Δ R 2 β Step 1.12** SRGS-R: Self.34** Step 2.19** SRGS-R: Self -.11 SRGS-R: Others.62 Step 3.00 SRGS-R: Self -.12 SRGS-R: Others.62 SRGS-R: Life.02 Step 4.00 SRGS-R: Self -.12 SRGS-R: Others.58 SRGS-R: Life.00 SRGS-R: Religion.08 Total R 2.31** n 107 Note. ** p <

75 Table 14 Predictors of Resourcefulness Scale Scores Resourcefulness Scale Scores Predictor Δ R 2 β Step 1.02 SRGS-R: Self.15 Step 2.10** SRGS-R: Self.48** SRGS-R: Others -.46** Step 3.00 SRGS-R: Self.46 SRGS-R: Others.47 SRGS-R: Life.04 Step 4.00 SRGS-R: Self.46 SRGS-R: Others -.45 SRGS-R: Life.05 SRGS-R: Religion -.06 Total R 2.12** n 107 Note. ** p <

76 Table 15 Predictors of Wisdom Scale Scores Wisdom Scale Scores Predictor Δ R 2 β Step 1.08** SRGS-R: Self.27** Step 2.00 SRGS-R: Self.37 SRGS-R: Others -.13 Step 3.08** SRGS-R: Self.16 SRGS-R: Others -.25 SRGS-R: Life.41 Step 4.00 SRGS-R: Self.16 SRGS-R: Others -.24 SRGS-R: Life.41 SRGS-R: Religion.02 Total R 2.16** n 107 Note. ** p <

77 Chapter 5 Discussion In general, there was weak support, at best, for the Janus Model in this sample. The results indicated that the Janus model fit the data poorly. Specifically, the correlations between distress and the illusory scales were not only in the opposite direction than predicted, but were different to a statistically significantly degree. The Janus Face Model and the Present Study The Janus Face model of posttraumatic growth represents an unconventional viewpoint in the still developing field of PTG research (Zoellner & Maerker, 2006). However the findings of the present study are more consistent with conventional thinking and previously published research on PTG. In particular, the relationship between trauma-related distress and illusory constructs were completely opposite to what would be predicted in the Janus Model. That is not to say that there was no support for the Janus Model in this sample. There were some, albeit weak, indications that the findings were in line with the Janus Model. For example, the constructive constructs were negatively correlated with distress, as predicted by the model. However, only one of those three relationships, between distress and capacity for love, were statistically significant. The other two relationships, distress correlated with resourcefulness and wisdom, were negative as would be predicted by the Janus Model, but were very weak. There are a variety of possible reasons why the Janus Model was not strongly supported by this study. First, it may be that the focal trauma events reported by participants were not of the type or intensity that would be associated with the type of 67

78 distress measured in this study. This is a difficult possibility to assess due, in part, to the highly individual nature of trauma response (Tedeschi & Calhoun, 2004). The use of a PTSD measure in assessing distress may have contributed to this possible effect, since PTSD represents a highly specific clinical manifestation of trauma-related symptoms that are most associated with lower base rate events such as combat exposure and sexual assault. Though events of this nature were present in the sample, they were in the minority. For example, the median scores for 13 of the 17 PPTS-R items were zero, indicating no experience of symptoms at all. Given this, a more neutral distress measure many have captured the phenomenon better. In addition to the wide variance of experience reflected in the reported events, it should be noted that on the PPTS-R, where they are asked to list the most traumatic and/or stressful event that they have ever dealt with, some participants reported a focal trauma event that they did not report on the TEI. It is unclear if the lack of reporting on the TEI was an intentional oversight, or if some participants misunderstood or misread the directions, or for other unknown reasons. Second, most PTG research has been conducted on specific trauma populations (Westphal & Bonanno, 2007). In the present study, participants were asked to report the most traumatic and/or stressful event they have ever been faced with. This resulted, not surprisingly, in a wide range of reported events. It is possible that having such a wide variance in focal event type influenced the overall scores, especially the distress and PTG scores. This may be due to individual differences, but could also be influenced by the nature of the events themselves. It is possible that certain type of stressful events have a similar trajectory or form. For instance, bereavement figured prominently in the sample. Bereavement as a trauma event is unique in the sense that there are cultural practices in 68

79 place which are designed to assist the person in the grief process (Tedeschi & Calhoun, 2004)). When someone experiences the death of someone close to them, it is not uncommon for them to be given time off from school or work responsibilities. In addition, many people experience the sympathy of family, friends, and perhaps even their community when they are working through their loss. Contrast this with experiencing a crime, such as sexual assault or a robbery. Though it has likely improved in recent decades, crime survivors may be revictimized by the criminal justice process, ranging from initial police contact through court proceedings (Tedeschi, 1999). Poor resources and lack of support that many crime survivors experience likely contribute to how well they are able to handle their distress. This is particularly relevant in relation to combat-related trauma. One could argue that our society learned the hard way that when soldiers return from war they require resources from both their loved ones and the larger society. When this does not occur, as it often did not with Vietnam veterans, the already difficult process of dealing with trauma becomes much harder (Shephard, 2000). To return to the original point, it is possible that the Janus Model would be supported in a more specific, less varied, trauma population with a larger amount of shared characteristics. Third, there may be developmental issues involved in the results. The present study had a very limited sample in terms of age, with the most common age being 19. Given that the present sample is almost exclusively young adults, the developmental aspects that influence their responses are different than those that would be found in a study with a wider range of adults. For example, the average age when most of the participants experienced their focal trauma event was years, with the median being 69

80 16 years. However, the reported ages of a sexual trauma event ranged from 3 years to 22 years of age. Given that young adulthood is in itself a unique developmental phase, the sample may view their experiences differently than older individuals who are more established in their adult roles. This is not to discount the possible growth in young adults, but rather, to highlight the role that an age range restriction may play in this sample. Tedeschi and Calhoun (2004) suggest that younger people may be more likely than older persons to report growth due to a greater openness to learn from their experiences. They argue that older individuals may be more likely to have already gained important insights into their life prior to their trauma event and that their capacity for change is reduced in comparison. Finally, the Janus Model may have not been better supported in this sample due to the measures used. As previously noted, the PTSD measure may have not best captured the event related distress present in the sample. In addition, the scales used to capture the illusory and constructive constructs may have measured a general, unitary factor, and may not have captured the hoped-for nuances. The generally high, positive correlations between the scales indicate that they may be measuring similar constructs. In addition, the response style of the respondents suggested an overall positive skew. For example, the sample responded almost overwhelmingly in a positive direction to all the illusory and constructive items. This may reflect demand characteristics, in which the respondents thought it would be normative to respond in a positive, self affirming manner to the items. This might also explain the overall small to high amount of posttraumatic growth reported in the sample. Though there are no clinical cutoffs published for PTG, the sample generally reported substantial levels of PTG. 70

81 The results of the present study are consistent with some previous PTG research, but differ from others. Consistent with Helgeson et al. (2006), women in the present study reported higher levels of PTG on the full scale (female mean = 44,38, male mean = 37.48), though the difference was not statistically significant. Tedeschi and Calhoun (2004) reported in a review of published PTG research that the rates of reported growth generally ranged from 30% to 80%. In the present study, a much larger 95.4% of the sample reported some amount of positive growth. This raises the previously mentioned issue of cutoff scores. One of the potentially difficult aspects of PTG research is the lack of published norms. In the present study, a conservative approach is suggested. If only participants who averaged at least a full scale score of 43 (averaging at least a score of plus one on each of the 43 items), are included in the PTG category, a much smaller 38% of the sample is included. This would place the present study on the lower end when compared to published PTG rates. The present findings are similar to aspects of Wild and Paivio s (2003) study of college students. As noted, college students have not been widely studied in PTG research. The authors reported a wide range of reported trauma events in their sample that was consistent with the array in the present sample. Specifically, bereavement also figured prominently in the Wild and Paivio (28%) sample. In the present study, bereavement as the focal trauma represented 38% of the cases. As previously noted, the present study s conceptualization of trauma severity appears to have been inadequate. This is largely due to the difficulty of assessing the construct given the highly individual nature of trauma experience. Nonetheless, there was virtually no relationship (r =.08) between PTG and trauma severity in this sample. It was 71

82 hypothesized that there would be a positive relationship between these variables but that did not emerge. This hypothesis was based on a dose-response theory of PTG, which suggests that as trauma exposure and severity of threat increases, there is a corresponding greater possibility of PTG occurring. The present findings differ from those of Zoellner, et al. (2008), who reported a significant positive correlation between PTG and trauma severity in their study of accident survivors. This discrepancy in findings highlights the difficulties measuring trauma severity. It is easier to measure subjective and objective trauma severity in a single incident trauma such as a car accident, in which there is generally both a perceived and real threat to the physical integrity of the person. It becomes more problematic when one is studying a trauma such as bereavement, in which there is unlikely to be a physical threat to one s safety. Though, there is no simple solution to this problem, more novel approaches to conceptualizing and studying trauma severity are needed. The Importance of Measuring Negative Growth What did emerge in this sample was the finding that participants will endorse negative growth experiences when given the opportunity. As previously noted, a common criticism of PTG research is that almost all measures that are used only allow respondents to report positive growth (Armeli, et al., 2001). One of the potential problems with that design is that it may pull for respondents to over-report their positive growth. The present study was designed to address this shortcoming by allowing participants to report negative, neutral, or positive growth reactions. The results indicated that, though in the minority, some participants reported overall negative growth on the PTG scales (Full scale PTG (n= 5), PTG Self scale (n = 3), PTG Others scale (n= 4), PTG Life scale (n = 72

83 6), PTG Religiosity scale (n = 22). This was particularly striking on the PTG religiosity scale, in which 22 participants reported negative growth. On one PTG item, as many as 22% of participants endorsed a negative response. These results indicate that PTG is not simply a positive response to trauma events, but rather, involves complex responses that need further study. Limitations There are a number of limitations to the present study. First, there may have been a pre-selection bias in the sample. Out of concern for the welfare of possible participants, it was deemed important to state in the sign-up posting that the study involved being asked about traumatic events. It is possible that some potential participants did not take part in the study based on this information. Conversely, some participants may have taken part in the study because of this disclosed information. It is possible that there were characteristics of both of these groups that impacted the results in some unknown manner. For example, it may be that people who have experienced growth may be more likely to sign up for a study in which they are going to be asked about their trauma history. Cromer, Freyd, Binder, De Prince, and Becker-Blease (2006) reported that undergraduates perceive questions related to their trauma history as being more important and having greater cost-benefit advantages than other types of personal information requests in research settings. Conversely, people who are distressed by a traumatic event may be less likely to want to participate in a study of this nature. These conditions might lead to higher growth scores and lower distress scores. Second, all the data collected relied on self-reported, recalled information. Consequently, the accuracy of responses cannot be verified. Self-report data is prone to a 73

84 wide variety of confounds, including memory problems and demand characteristics (Elmes, Kantowitz, & Roediger III, 1999). In addition, no corroborating information was obtained that would have supported the participant s responses, such as third party reports. Third, there may have been a priming effect, such that participants were more likely to respond in a certain way based on the presentation of the material. In general, knowing that a study is attempting to measure your responses to a trauma event, may make some participants wish to present themselves in a falsely positive (or negative) light (Elmes, Kantowitz, & Roediger III, 1999). In particular, after having been presented with the positively worded items related to growth on the SRSG-R, participants may have been more likely to respond in a positive manner to the items on the illusory and constructive scales. Finally, the study did not have a large enough sample to allow specific event categories to be meaningfully compared. A much larger sample in a college population would likely be needed to have enough people in the various categories to make reasonable statistical comparisons. Clinical Implications Present findings have a variety of clinical implications. First, participants overwhelmingly reported experiencing growth as result of struggling with an event or situation in their life. Even if the sample over-reported their growth, as previously suggested, it appears that this phenomenon is likely to be occurring in a large number of people. More importantly, it is apparently occurring in response to a wide array of events and situations. As clinicians, it is important to consider that people face struggles with 74

85 many types of experiences that are not traditionally viewed as being traumatic. Examples from this sample would be parents divorce and the incarceration of a parent, both of which are no longer low base rate incidents in our society. The motivation should not be to pathologize more in our society, but rather, to understand these struggles as being a common part of the human experience. A second clinical implication is that growth should be viewed as more complex than perhaps previously thought. Often it appears that trauma reactions are viewed in a dichotomous manner, as being either pathological or positive. Specifically, participants in this sample often reported both positive and negative growth across a range of items. In other words, there are nuances to even the positive aspects of trauma experience that need to be considered when working with this population. Finally, the wide range of reported trauma events and corresponding reactions in this sample highlights the possibility of viewing trauma in a dimensional way. Currently, PTSD is the primary DSM-IV diagnosis for trauma-related experience. While PTSD certainly has a role to play in our conceptualization, its dichotomous nature is problematic. Currently, you either have PTSD or you don t. In other words, there is no range of trauma reaction currently diagnosable. The present sample suggests that there is a wide variation in the events themselves, and in the manner in which people respond to very stressful events. From a clinical standpoint, more people may be able to receive help if a dimensional approach was utilized and better treatments could be developed for a wider range of trauma situations. 75

86 Research Implications The present study also has important research implications. First, most growth research has taken place with specific trauma populations. While this is definitely important to do, it is also necessary to assess how growth is related to a broader range of experience. By examining growth in a college population, for example, it is possible to gain valuable information about normative experiences for young adults in our society. In addition, investigating growth in a broader population allows for a better understanding of the construct of PTG. Second, the present findings contradict results from a similar study (Zoelner, et al., 2008) that also examined the Janus Model. Specifically, that study reported low levels of posttraumatic growth in their sample. Among the possible reasons for differences in the outcomes are cultural issues. The Zoelner et al. study was conducted in Germany, where the authors suggest there is less of a tendency to display overtly positive attitudes and beliefs. They go further and argue that America displays a tyranny of positive thinking. Given that much of the research on growth is originating in Europe, perhaps cultural issues should be given a higher profile in the discourse on posttraumatic growth. Anecdotally, in the course of the present study several international students, representing a variety of foreign cultures, voiced a lack of understanding with the concept of trauma. One international student pointed out that in the country where he grew up in Africa events of the nature mentioned in the TEI simply do not occur, suggesting that he viewed the concept of trauma as a completely American construction. The positive response style of participants in the present study has already been noted and this may, in part, reflect these cultural differences. 76

87 Future Directions This study highlights the need for continued refinement of methods for posttraumatic growth research. Particularly promising are the methods employed by Shakespeare-Finch and Enders (2008), in which they utilized a significant other to corroborate growth scores. Also, more longitudinal growth studies are needed in order to better understand the long term course of posttraumatic growth. Studies such as those by Kleim and Ehlers (2009), hint at the insights that may be gained from such innovative research designs. Employing a longitudinal design in their study of assault survivors, Kleim and Ehlers identified a curvilinear relationship between PTG and both depressive and PTSD symptoms. Though it is unlikely to be resolved to anyone s satisfaction in the near future, the field of posttraumatic growth theory, research, and practice must come to terms with a number of major issues. First, what role does a person s behavior play in growth? In general, we have only studied the individual s self-report of cognitive constructs. The issue of whether behavioral action is important, or perhaps even required, to define growth is still debated (Hobfoll, et al. (2007). One possible approach would be to introduce more research designs that combine quantitative and qualitative methods. It may be easier to examine some of these research questions with less rigid approaches than are presently employed. A second important issue related to the adaptive role of growth is avoidance. Avoidance is viewed as a major component in clinical manifestations of trauma and plays a central role in the current conceptualization of PTSD. The issue is whether PTG 77

88 facilitates avoidance and short term anxiety reduction, therefore, ultimately inhibits long term adaptive functioning. Differing theoretical perspectives on the issue of the adaptive significance of PTG have led to the development of entrenched camps (Zoellner & Maercker, 2006). Hobfoll, et al. (2007) argues that PTG without being accompanied by observable, related behaviors (such as becoming more active in your church or returning to college to earn a degree) may largely serve as a positive illusion that may facilitate avoidance. In sharp contrast, Tedeschi and Calhoun (2007) argue that, though it is not the only important facet of PTG, cognitions are vital to an individual s post-trauma experience and that they should not be discounted because they are not quantifiable by the naked eye. It is argued in the present study, however, that raising the issue of adaptive functioning is not only valid, but is imperative before posttraumatic growth can be accepted more widely and utilized in treatment of trauma. The adversities people face vary greatly among individuals, but they generally have certain shared qualities. They tend to be sudden, uncontrollable, and severely strain the individual s resources to handle them. As Tedeschi and Calhoun (2004) point out in their conceptualization of posttraumatic growth, it is the struggle through which the growth is developed, not the event itself. Though the present study found a wide range of events and situations that people reported as being very stressful, it is not the intent to further pathologize everyday human struggles and dub them as tr aumatic. Rather, it is the very commonness of these events that underscore the need for a better understanding of how people face and, in some cases, grow as a result of adversity. 78

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95 Appendix A University of Toledo Psychology Department 2801 West Bancroft Street Toledo, Ohio ADULT RESEARCH SUBJECT - INFORMED CONSENT FORM The Two Sides of Posttraumatic Growth: A Study of the Janus Face Model In a College Population Principal Investigator: Mojisola F. Tiamiyu, Ph.D., Associate Professor, Darren R. Jones, M.A, Student Investigator, Purpose: You are invited to participate in the research project entitled, The Two Sides of Posttraumatic Growth: A Study of the Janus Face Model In a College Population. The study is being conducted at the University of Toledo under the direction of Dr. Mojisola F. Tiamiyu and Darren R. Jones, M.A. The purpose of this study is to investigate the impact of traumatic events on an individual s life experience. You need not have experienced a traumatic event to take part in the study. Description of Procedures: This research will take place in the psychology department, which is located on the first floor of UHALL and will take approximately one hour. You will be asked to complete various questionnaires in which you will be asked to report any past traumatic events that you may have experienced in your life. Traumatic events include, but are not limited to, violent crimes, abuse, serious accidents, and disasters. You will also be asked about how these past events have impacted your life and how you view them currently. After you have completed your participation, the research team will debrief you about the data, theory and research area under study and answer any questions you may have about the research. Potential Risks: There are minimal risks to participation in this study, including loss of confidentiality. Answering the surveys (or participating in this study) might cause you to feel upset or anxious. If so, you may stop at any time. Potential Benefits: The only direct benefit to you if you participate in this research may be that you will learn about how psychology studies are run and may contribute to our understanding of the impact of traumatic life experiences. 85